CAESAREAN SECTION PATELIYA BHARGAV GROUP NO 163 B

through an abdominal and uterine incision, after the period of

viability

live fetus)
Dystocia (Ineffective or prolonged labour)
Cord prolapse
Failed trial of Forceps

/ Vacuum delivery
Fetal malformations likely to cause obstructed labour
High order multifetal gestation

mellitus
Intra uterine growth restriction
Rh isoimmunization
Previous unexplained IUFD

in upper segment
Contracted pelvis
Placenta praevia
Previous VVF repair / Stress

incontinence repair
Cord presentation
Fetal compromise
Pregnancy with Carcinoma cervix
Fibroid / Ovarian tumor causing obstruction
Genital tract malformations of the cervix / vagina

of induction
Antepartum haemorrhage

to
Increased safety of the procedure
Decrease in parity ( Proportion of

nulliparas is more)
Older / Infertile / High risk women are having children
Previous Caesarean sections
Increased detection of fetal distress by EFHRM
Breech presentations predominantly delivered by LSCS
Decrease in difficult operative vaginal deliveries
Concern for malpractice litigation
Improving socio economic status

of abdominal delivery
Intrauterine fetal death
Gross congenital malformations
Extreme prematurity
Coagulation defect

a planned procedure to ensure optimal preoperative preparation and surgical

conditions
EMERGENCY
When the caesarean section is done because of sudden deterioration in maternal / fetal condition or during labour due to non progress / failed induction / failed trial

IV half to one hour before the procedure
Inj Metoclopramide 10

mg IV half to one hour before the procedure
Stomach should be empty
Bladder should be catheterized
Fetal presentation, position and FHS should be checked

prevent supine hypotension / venocaval compression may be given

/ Joel-Cohen)
Post op pain is less
Less chance of wound dehiscence

/ incisional hernia
Cosmetically better
Vertical infraumbilical midline
Rapid entry into abdomen
Capable of extention
Blood loss minimal

to less vascularity
Less active uterine segment
Healing better
Stretch during subsequent pregnancy

is along the line of incision
Chances of rupture during subsequent pregnancy / labour are less
Classical ( Upper segment vertical )

of adhesions
Lower segment approach is not possible due to
Anterior placenta

praevia
Large fibroids in the lower uterine segment
Transverse lie ( Dorso inferior positions)
Pregnancy with Carcinoma cervix
Post mortem caesarean section

part of the abdominal incision to expose the lower uterine

segment
Recognition of lower uterine segment is by the presence of loose peritoneum over it
The loose peritoneum is incised transversely and the bladder is pushed down
Lower uterine segment incision should be made after centralizing the uterus to avoid injury to the uterine vessels coursing along the lateral walls of the uterus
Lower uterine segment incision is made in the middle, deepened till the membranes are reached and then extended laterally by stretching to create a 10 cm opening

operator and delivered while the assistant applies fundal pressure
The placenta

and membranes are delivered and the inside of the uterus is inspected for any abnormalities and completeness of removal of contents
Green Armytage haemostatic clamps are applied to the angles and the margins of the uterine incision to achieve control of bleeding
The uterine incision is closed in a single layer with chromic catgut No: 1 or No: 2 using a interlocking running suture to achieve haemostaisis
It is not necessary to close the visceral and parietal peritoneal layers
Peritoneal toilet is done and the abdomen is closed in layers.

2500ml)
Antibiotics as per hospital policy
Pain relief
Care of the bladder
Monitor
Vital parameters
Vaginal

bleeding
Urine output
Hydration

fluids after 24 hrs
Discharge from hospital after 96 hrs
Stitch removal

on 7th post operative day
To avoid exertion for 4 – 6 weeks
Contraceptive advice

in future pregnancies
Scar rupture
Repeat caesarean