Caesarean section is the delivery of a fetus through an incision made in the mother's abdomen and uterus. It was originally a fatal operation but is now commonly performed worldwide. The WHO recommends an ideal c-section rate of 15-20% though rates have increased due to factors like previous c-sections and increased fetal distress diagnosis. C-sections are performed under spinal or epidural anesthesia with various abdominal incision types closed afterwards. Complications can include hemorrhage, infection, and injury to internal organs during the operation or issues like ileus, DVT and wound separation after.
2. WHY CALLED SO??
According to legend ,julius caesar was born
by this operation
It was a fatal operation until beginning of 20th
century.
Now the most common operation performed
worldwide
3. DEFINITION
The delivery of a viable fetus through an incision in
the abdominal wall and uterus.
Definition does not include removal of fetus from
abdominal cavity in case of rupture uterus.
WHO recommends an ideal caesarean rate of 15-
20%.
But in most countries it is 15-20%
4. WHY RATES INCREASED?
Increase in repeat caesareans.
Difficult instrumental delivery and vaginal
breech deliveries
Increased diagnosis of intrapartum fetal
distress
Caesarian on demand
Identification of risk of mothers and fetuses
Increase in pregnancies by invitro fertilization
5. INDICATIONS
Previous caesarian section
Dystocia or dysfunctional labour
Fetal distress
Breech presentation
Antepartum haemorrhage
Maternal problems
Caesarian section on demand
7. • Cross matched blood
• Catheter introduced
• Antibiotic prophylaxis
• Heparin as thromboprophylaxis
• Parts cleansed with antiseptic solution
• Left lateral position- reduce aortocaval
compression.
reduce risk of supine
hypotension
8. ANAESTHESIA
• GA or REGIONAL
• REGIONAL - Spinal or Epidural
• Mendelson’s syndrome- GA given as
emergency- risk of aspiration- chemical
pneumonitis.
• To counteract- antacids given during
labour, oral fluids withheld
• 30 ml 0.3 molar sodium citrate orally -1/2 hr
before surgery.
• Sellick’s manoeuvre- endotracheal
intubation accompained by pressure on
10. Maylard incision
Option when more exposure is
needed in transverse incision
Recti muscles are divided
Midline vertical incision
11. Transverse Vertical incision
incision
Cosmetic appeal More Less
Postoperative pain Less More
Wound dehiscence Less More
Incisional hernia Less More
Technical skill More Less
Time taken More Less
Access to upper Less Good, can be
abdomen extended
12. PROCEDURE
• Once abdomen opened- dextrorotation of
uterus corrected
• Doyen retractor- visualize lower segment
• Peritoneum over lower segment identified-
divided transversely- seperated from bladder
by blunt dissection
• Small incision in lower segment-extended
laterally
• Inadequate space- J shaped or inverted T
incision
• Do not injure uterine vessels lying laterally
13. DELIVERY OF BABY
Cephalic presentation
Hand slipped into uterine cavity
Head is levered out gently
Floating head- use forceps to deliver the
baby.
Breech presentation
feet hooked out first
rest delivered as vaginal breech
delivery
14. Transverse or oblique lie
corrected to longitudinal lie before
making uterine incision.
Transverse lie with ruptured
membranes & undeveloped lower
segment
extension of uterine incision
required
15. CLOSURE OF UTERINE INCISION
OXYTOCIN infusion started as soon as
baby is delivered
Uterine fundus contracts-placenta and
membranes extrudes spontaneously-
removed
Wipe with moist pad- ensure uterine cavity
is empty and cervical canal is open
Uterine edges- held with ALLIS forceps or
GREEN ARMYTAGE forceps- incision
closed in 2 layers- continuous sutures
16. Chromic catgut or polyglactin used
Any bleeding points- controlled with figure-
of-eight sutures
17. CLOSURE OF ABDOMEN
• PERITONEUM- closed or not closed
• RECTUS SHEATH-non absorbable sutures-
proline- to reduce wound dehiscence &
incisional hernia
• SUBCUTANEOUS TISSUE-closed
• SKIN- mattress sutures of silk, subcuticcular
suture or clips
19. Close monitoring for 1st 6-8 hrs
Parenteral fluids
Blood transfusion if needed
Analgesics and sedatives
Oral fluids
Early ambulation and deep breathing
exercises
Light solid diet n laxatives
Discharged –day following suture
removal/if transverse or subcuticular-5th/6th
day
22. LOWER SEGMENT VERTICAL INCISION
Indications:Constriction ring,lower segment
not formed
Disadv:
injury to cervix, vagina,bladder
increased chance of rupture in next
pregnancy
23. CLASSICAL CAESAREAN
Indications
lower segment unapproachable
CA cervix
Anterior placenta praevia with prev caesarian
Transverse lie with ruptured membranes
Conjoint twins
Disadvantages
Difficult healing
Scar rupture
General peritonitis
27. INTRAOPERATIVE COMPLICATIONS
Primary haemorrhage
Injury to internal organs
Injury to the baby
Difficulty in delivery of the head
Anaesthetic complications
28. PRIMARY HAEMORRHAGE
Atonic-
oxytocin 20units in 500ml
ergometrine0.25mg im or iv
prostaglandin F2 alpha 250micgram im and
intramurally
PGE1 200micgram rectally
Traumatic-ligation of concerned vessels
Placenta accreta