This document discusses caesarean section (CS), including the different types (primary vs repeat), rising CS rates due to various factors, and indications for CS. It also covers the details of lower segment CS vs classical CS, including techniques, risks, and benefits. Complications of CS and measures to reduce unnecessary CS are also mentioned.
2. • It is an operative procedure whereby the
fetuses after the end of 28 th week are
delivered through an incision on the
abdominal and uterine walls.
• The first operation performed on a patient is
referred to as primary caesarean section
• When the operation is performed in
subsequent pregnancies ,it is called repeat
caesarean section.
3. FACTORS FOR RISING CAESAREAN
SECTION RATE
• Identification of at risk fetuses before term
• Identification of at risk mother
• Wider use of repeat cs in cases with previous
Caesarean delivery.
• Rising rate of induction of labour and failure of
induction
• Decline in operative vaginal delivery and manipulative
vaginal delivery
• Delivery in vaginal breech delivery
• Increased number of women with age ..>30 and
associated medical complication
4. • Caesarean delivery on demand
• Increased diagnosis of fetal distress
• Fear of litigation in obstetric practice
5. INDICATION
• Absolute indication
• Vaginal delivery is not
possible
• Central placenta previa
• Contracted pelvis or
cephalopelvic
disprportion
• Pelvic mass
• Advanced carcinoma
cervix
• Relative indication
• Cephalopelvic
disproprtion
• Previous caearean
delivery
• Nonreassuring FHR
• Dystocia may be due
to 3p
6. ABSOLUTE
• Vaginal obstruction
• Common indication –Primi
• Multi
RELATIVE
• Antepartum haemorrhage
• Malpresentation
• Failed surgical induction of
labour
• Bad obstetric history
• Hypertensive disorders
• Medical or gynaecological
disorders
7. TIME OF OPERATION
• Elective-Prearranged time
• Emergency-unforseen or acute obstetric
emergencies.
8. TYPES OF OPERATION
• Lower segment caesarean section(LSCS)- In
this operation, the extraction of baby is done
through an incision made in the lower
segment through a trans peritoneal approach
• Classical-In this operation baby is extracted
through an incision made in the upper
segment of uterus
9. LSCS
• Transverse incision-Advantages;Post operative
discomfort is more,Fundus of uterus can be
better palpated during immediate postoperative
period,Less chance of wound dehiscence,Less
chance of incisional hernia,Cosmetic value
• Disadvantages----Takes alittle longer time, Blood
loss is slightly more,Requires competency during
repeat section,Unsuitable for classical operation
11. LOWER SEGMENT
• Technically slight difficult
• Blood loss is less
• Wall is thin and as such
apposition is perfect
• Perfect peritonisation is
possible
• Technical difficulty in
placenta praevia or
transverse lie.
CLASSICAL
• Technically easy
• Blood loss is more
• Wall is thick and apposition
of margin is not perfect
• Perfect peritonisation not
possible
• Comparatively safer in such
circumstances
12. • Haemorrhage and shock is
less
• Peritonitis is less
• Peritoneal adhesion and
intestinal obstruction are
less
• Convalescence is better
• Morbidity and mortality are
much lower
• More
• Chance of peritonitis is
more
• More because of imperfect
peritonisation
• Relatively poor
• Morbidity and Mortality are
high
13. LOWER S EGMENT
• Perfect muscle apposition
due to thin margins
• Minimal wound haematoma
• Wound remains quiscent
durin g healing process
• Chance of gutter formation
is unlikely
• Scar rupture is less (0.51.5%)
CLASSICAL
• Imperfect apposition
• More wound haematoma
formation
• Wound is in a state of
tension due to contraction
and relaxation of the upper
segment
• Chance of gutter formation
on the inner aspect is more
• Scar rupture -4-9%
14. MERITS AND DEMERITS
LOWER SEGMENT TRANSVERSE
• Extension of incision may
occur to involve the uterine
vessels
• Bladder dissection is
minimal
• Uterine closure –easy
• Muscle apposition –good
• Reperitonisation –complete
• Intra operative bleeding less
• Subsequent adhesion -less
LOWER SEGMENT vertical
• Involve the upper segment
or downward the bladder
• More when extends
inferiorly
• Difficult
• Imperfect
• Imperfect
• More
• More
