This document provides an overview of cesarean section (C-section). It defines a C-section as a surgical procedure to deliver babies through incisions in the abdominal and uterine walls after 28 weeks of gestation. The C-section rate in the US has risen from 5% in 1970 to 31.9% in 2016. While it poses risks, C-section can be the safest delivery method for some women and babies. The document then describes the personnel, procedures, types, indications, risks, and postoperative care of C-sections.
2. INTRODUCTION
Cesarean section is a fetal delivery through an open abdominal incision (laparotomy) and an
incision in the uterus (hysterotomy). The first cesarean documented occurred in 1020 AD, and
since then, the procedure has evolved tremendously. It is now the most common surgery
performed in the United States, with over 1 million women delivered by cesarean every year. The
cesarean delivery rate rose from 5% in 1970 to 31.9% in 2016. Though there are continuing
efforts to reduce the rate of cesarean sections, experts do not anticipate a significant drop for at
least a decade or two. While it confers risks of both immediate and long-term complications, for
some women, cesarean delivery can be the safest or even the only way to deliver a healthy
newborn.
3. DEFINITION
It is an operative procedure whereby the fetuses after the end of 28th
week are delivered through an incision on the abdominal and uterine
walls.
4. MATERNAL INDICATIONS FOR CESAREAN
Prior cesarean delivery
Maternal request
Pelvic deformity or cephalopelvic disproportion
Previous perineal trauma
Prior pelvic or anal/rectal reconstructive surgery
Herpes simplex or HIV infection
Cardiac or pulmonary disease
Cerebral aneurysm or arteriovenous malformation
Pathology requiring concurrent intraabdominal surgery
Perimortem cesarean
5. UTERINE/ANATOMIC INDICATIONS FOR CESAREAN
Abnormal placentation (such as placenta previa, placenta accreta)
Placental abruption
Prior classical hysterotomy
Prior full-thickness myomectomy
History of uterine incision dehiscence
Invasive cervical cancer
Prior trachelectomy
Genital tract obstructive mass
Permanent cerclage
7. THE PRIMARY PERSONNEL FOR A CESAREAN SECTION
CONSISTS OF:
The surgeon
The surgeon’s assistant
The anesthesiologist or anesthetist
A scrub nurse or technician
A circulating nurse
Someone to care for the neonate
8. TYPES OF C SECTION
Classical caesarean section
This is rarely performed. It involves a vertical incision made through the visceral
peritoneum and the contractile part of the uterus above the bladder
Indications
Gestational age less than 32 weeks before the lower segement are formed
Placental praevia
Fetus in a transverse lie
Shoulder presentation
9. Advantages of Classical caesarean section
It doesn't take much time to perform It can be employed when general
anaesthesia is not available
Disadvantages of Classical caesarean section
Rupture of a uterine scar in subsequent pregnancy
Haemorrhage is greater
Small bowel adhesion to the anterior suture line
Delayed wound healing
10. Lower segment caesarean section
This is possible by means of transverse incision through the lower uterine
segment.
Advantages
Less danger of infection or haemorrhage
Less incidence of uterine rupture in subsequent pregnancies
It is the caesarean section mostly employed by obstetricians
11. METHODS OF C SECTION
Elective caesarean section
This type is used when the caesarean section is performed at a scheduled
time, such with a known fetus pelvic disproportion. The patient is
usually admitted to the hospital the day prior to surgery. This allows for
laboratory investigations and provides an opportunity to rule out
presence of infection
Emergency caesarean section
Here, there is no indication of caesarean section prior to the surgery. It is
usually done when a woman must have laboured with failure and there
is an urgent need to save the life of both the mother and the child or
either
12. CONTRAINDICATIONS
Dead foetus: except in
a. Extreme degree of pelvic contraction.
b. Neglected shoulder presentationc.
Severe accidental haemorrhage.
Disseminated intravascular coagulation(bloodcoagulation disorder): to minimise blood
loss.
Extensive scar or pyogenic infection in theabdominal wall e.g. in burns.
Too premature baby.
15. STEP BY STEP C-SECTION PROCEDURE
Preparation
Anesthesia
Initial incision
Follow-up incisions
Suctioning of amniotic fluids
Delivery of the baby's head
Delivery of the baby's shoulders and body
Birth of the baby
Cutting of the umbilical cord
Delivery of the placenta
Closing the incision
Recovery
16.
17. DELIVERY OF THE PLACENTA
The next steps are the delivery of the placenta, followed by the suturing of the uterus
and all the layers that were cut during the surgery. Once the placenta has been
removed, it will be examined by your doctor.7 Closing up everything that's been cut
through to get to the baby is usually the longest part of the cesarean section, which
in total typically takes about 30 to 60 minutes to complete.
During this time you can usually have your baby with you to breastfeed or hold.
However, don’t feel pressure to begin breastfeeding immediately, you can start any
time in the first hours after your baby is born—a small delay won’t cause any harm.
Simply enjoying your baby however works best for you is fine. It may also be possible
for your support person to hold the baby close to your face if you are unable to hold
your baby.
18. SUTURING
• Double row suture
• first row - continuous
mucous - muscular
sutures
• second row - continuous
muscular-muscular
sutures
• peritonization - restoring
the integrity of the plica
vesico-uterina
19. CONCLUDING PART
Peritoneal toileting is done and the blood clots
are removed
• The tubes and ovaries are examined
• After being satisfied that the uterus is well
contracted, the abdomen is closed in layers
• The vagina is cleansed of blood clots
• The blood loss is commonly between 500 and
• 1000 ml
20. UTERINE RUPTURE, PERIOPERATIVE AND PERINATAL MORBIDITY AFTER
SINGLE-LAYER AND DOUBLE-LAYER CLOSURE AT CESAREAN DELIVERY.
Single-layer uterine closure is associated with decreased infectious morbidity in the
index surgery, but not uterine rupture or other adverse outcomes in the subsequent
gestation.
21. FIRST-BIRTH CESAREAN AND PLACENTAL ABRUPTION OR PREVIA AT
SECOND BIRTH
Among our study cohort, abruptio placentae complicated 11.5 per 1000
and placenta previa 5.2 per 1000 singleton deliveries at second births. In
logistic regression analyses adjusted for maternal age, women with
first-birth cesareans had significantly increased risk of abruptio
placentae (OR 1.3, 95% CI 1.1, 1.5), and placenta previa (OR 1.4, 95% CI
1.1, 1.6) at second births, compared with women with prior vaginal
deliveries.
22.
23. POSTOPERATIVE CARE.
Observation for the first 6–8 hours is important. Periodic check up of pulse, BP,
amount of vaginal bleeding and behavior of the uterus is done and recorded
• Fluid: Sodium chloride (0.9%) or Ringer’s lactate drip is continued until at least 2
– 2.5 liters of the solution are infused. Blood transfusion is required if the blood loss
is more than average during the operation (average blood loss in cesarean section is
approximately 0.5 to 1 liter)
• Oxytocics: Injection oxytocin 5 units IM or IV (slow) or methergin 0.2 mg IM is
given and may be repeated
• Prophylactic antibiotic (cephalosporins, metronidazole) for all cesarean delivery
is given for 2–3 days. Therapeutic antibiotic is given when indicated
24. Analgesics in the form of pethidine hydrochloride 75-100 mg is administered and
may have to be repeated
• Ambulation:The patient can sit on the bed or even get out of bed to evacuate the
bladder, providednthe general condition permits. She is encouraged to move her
legs and ankles and to breathe deeply to minimize leg vein thrombosis and
pulmonary embolism
• Baby is put to the breast for feeding after 3–4 hours when mother is stable and
relieved of pain
25. Day 1: • Oral feeding in the form of plain or electrolyte water or
raw tea may be given. Active bowel sounds are observed by the
end of the day.
• Day 2: • Light solid diet of the patient’s choice is given. • Bowel
care: 3–4 teaspoons of lactulose is given at bed time, if the
bowels do not move spontaneously.
• Day 5 or Day 6: The abdominal skin stitches are to be removed
on the D-5 (in transverse) or D-6 (in longitudinal).
• Discharge: The patient is discharged on the day following
removal of the stitches, if otherwise fit. Usual advices like those
following vaginal delivery are given. Depending on postoperative
recovery and availability of care at home, patient may be
discharged as early as third to as late as seventh postoperative day.