CESAREAN SECTION CS CESAREAN SECTION Cs Ghadeer AlShaikh

CESAREAN SECTION CS

CESAREAN SECTION Cs Ghadeer Al-Shaikh, MD, FRCSC Assistant Professor & Consultant Obstetrics & Gynecology Urogynecology & Pelvic Reconstructive Surgery

TYPES OF CS n n Lower segment CS Classical CS

Indications for classical CS n n n Transverse lie back down (with SROM) Structural abnormality that makes lower segment approach difficult (Fibroids) Anterior Placenta Previa & abnormally vascular lower segment Poorly developed lower segment in Very preterm fetus in breech presentation Cervical cancer

INDICATIONS FOR ELECTIVE CS n n n Repeat CS Placenta previa VV fistula repair HIV (poor controlled) Active herpes Fetal macrosomia > 4500 gm n n n Uterine surgery eg. Hystrotomy, myomectomy Severe IUGR Breech Multiple pregnancy Transverse lie Ca of the Cx/ TR obstructing the birth canal

INDICATIONS FOR EMERGRENCY CS n n n n n Severe PET Abruptio placenta (APH) Fetal distress Failure to progress in the first stage of labour Cord prolapse Obstructed labour Failed induction Malpresentation brow, chin post, shoulder & compound presentations, breech Compromised fetus 2 ry to DM, HPT, isoimmunization

TIMING OF ELECTIVE CS n Usually at 38 -39 wks

Before Emergency CS n Explain to the Pt & husband & obtain consent n Inform anesthetist, OR staff, ped n 100% oxygen mask in case of fetal distress n Sodium citrate 20 ml , metoclopramide 10 mg IV n Transfer to theatre, IV , take blood for Hb, xmatch 2 U of blood Preferable to use spinal or epidural anaethesia n

n n n Catheterize the bladder Tilt the mother 15 º by using wedge Pneumatic inflatable boots or Ted stockings Prophylactic Ab ↓↓ incidence of infection Inform ped if the mother had opiates in the last 4 hrs Halothane should not be used uterine relaxation & bleeding

COMPLICATIONS INTRAOPERATIVE n Bleeding & the need for bl transfusion n Hysterectomy n Complications of anaesthesia n Damage to the bladder, ureter, colon , retained placental tissue n Fetal injury

COMPLICATIONS POSTOPERATIVE n Paralytic ileus n Wound dehiscence & infection n Infectins UTI, pnemonea n DVT & pulmonary embolism n Fistula n Death

POSTNATAL CARE n n n V/S & blood loss must be monitered Uterine fundus palpated Effective parentral analgesics Deep breathing & coughing encouraged Early mobilization Fluid therapy &diet Bladder & bowel function Wound care Lab Breast care Prophylaxis for thrombembolism

MODE OF DELIVERY IN NEXT PREGNANCY CRITERIA FOR VBAC n Pt must agree to the procedure n A low transverse uterine incision n Non recurrent cause of the previous CS n No macrosomia, malposition, multiple gestation, breech

MODE OF DELIVERY IN NEXT PREGNANCY Contraindication n Previous classical CS n 2 or more previous CS n Previous other uterine surgery n Hx of scar rupture n Placentaprevia or transverse lie

CONDUCT OF LABOUR Observe for n Progress n Fetal wellbeing n Maternal well being n Epidural n HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

Risk of SCAR RUPTURE n n O. 5% for LSCS 4 -9% for classical

SCAR RUPTURE Signs OF SCAR RUPTURE n Fetal distress n Ease of fetal palpation n Cessation of contractions n Elevation of presenting part n Scar pain n Bleeding / shock

ABNORMAL LABOUR/DYSTOCIA/FAILURE TO PROGRESS IN LABOUR CAUSES 1 -Abnormalities of the pasage n n Alteration in the shape of the pelvis Mass occupying the birth canal

ABNORMAL LABOUR/DYSTOCIA/FAILURE TO PROGRESS IN LABOUR 2 -Abnormalities in the passenger n Abnormal lie n Abnormal presentation occiput-postrior, occiput-transverse brow face breech n Macrosomia , perinatal mortality 5* higher than N Wt n Congenital malformation n Multiple gestation

ABNORMAL LABOUR/DYSTOCIA/FAILURE TO PROGRESS IN LABOUR 3 -Abnormalities in the powers n Ineffective uterine activity n Lack of voluntary expulsive efforts in the 2 nd stage DYSTOCIA IS THE MOST COMMON INDICATION FOR CS