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CESAREAN SECTION

CESAREAN SECTION. Tayebeh gharibi Faculty of nursing&midwifery. TYPES OF CS. Lower segment CS Classical CS Indications for classical incision: Transverse lie with SROM Structural abnormality that makes lower segment approach difficult Constriction ring with neglected labour

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CESAREAN SECTION

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  1. CESAREAN SECTION Tayebeh gharibi Faculty of nursing&midwifery

  2. TYPES OF CS • Lower segment CS • Classical CS Indications for classical incision: • Transverse lie with SROM • Structural abnormality that makes lower segment approach difficult • Constriction ring with neglected labour • Fibroids in the lower segment • Ant PP & abnormally vascular lower segment • Mother dead & rapid delivery is required • Very preterm fetus in breech pres

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

  4. INDICATIONS FOR EMERGRENCY CS • Abruptioplacntae • Fetal distress • Failure to progress in the first stage of labour • Cord prolapse • Obstructed labour • Failed induction • Malpresentation brow, face, shoulder & compound presentations, breech • Compromised fetus 2ry to DM, HPT, isoimmunization

  5. اندیکاسیونهای مادری • سرکلاژ دائمی • دفرمیته لگن • گسیختگی انسزیون رحمی • سابقه میومکتومی • توده های انسدادی ژنیتال • سرطان مهاجم سرویکس • بیماری قلبی یا ریوی • انوریسم مغزی • زایمان سزارین هنگام مرگ • ضایعاتی که مستلزم جراحی داخل شکمی همزمان هستند

  6. اندیکاسیونهای مادری جنینی • عدم تناسب سری لگنی • شکست خوردن زایمان واژینال ابزاری • پلاسنتا پرویا ودکولمان

  7. اندیکاسیونهای جنینی • وضعیت غیراطمینان بخش • نمایش غیرطبیعی • ماکروزومی • ناهنجاری مادرزادی • نتیجه غیرطبیعی داپلر عروق بندناف • ترومبوسیتوپنی • سابقه ترومای زایمانی نوزادان قبلی

  8. موربیدیتی نوزادان پارگی پوست شایعترین سفالوهماتوم شکستگی جمجمه فلج عصب فاسیال سزارین پس از شکست زایمان واژینال ابزاری .بیشترین میزان اسیب کمترین میزان آسیب در سزارین الکتیو

  9. TIMING OF ELECTIVE CS • For maternal interest  no choice • For fetal interest consider maturity & fetal condition • Usually at 38 wks

  10. Before Emergency CS • Explain to the Pt & husband & obtain consent • Inform anesthetist, OR staff, ped • 100% oxygen mask in case of fetal distress • Sodium citrate 30 ml , metoclopramide 10 mg IV • Transfer to the theatre, IV , take blood for Hb, x-match 2 U of blood • Preferable to use spinal or epidural anaethesia

  11. Catheterize the bladder • Tilt the mother 15 º by using wedge • 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

  12. COMPLICATIONS INTRAOPERATIVE • Bleeding & the need for bl transfusion • Hysterectomy • Complications of anaesthesia • Damage to the bladder, ureter, colon , retained placental tissue • Fetal injury POSTOPERATIVE • Gaseous distension • Paralytic ileus • Wound dehiscence & infection • Infectins  UTI, pulmonary • DVT & pulmonary embolism • Death • Vesico uterine fistula

  13. POSTNATAL CARE • 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

  14. MODE OF DELIVERY IN NEXT PREGNANCY CRITERIA FOR VBAC • Pt must agree to the procedure • A low transverse uterine incision • Non recurrent cause of the previous CS • No macrosomia, malposition, multiple gestation, breech Contraindication • Previous classical CS • 2 or more previous CS • Previous other uterine surgery • Hx of scar rupture • Placentaprevia or transverse lie

  15. CONDUCT OF LABOUR Similar to the conduct of normal labour Observe for • Progress • Fetal wellbeing • Maternal well being • Cx may be ripened • Labour may be agumented • Epidural & other analgesics may be used • HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

  16. SCAR RUPTURE • O.2-1.5% for LSCS • 4-9% for classical INDICATIONS OF SCAR RUPTURE • Fetal distress • Ease of fetal palpation • Cessation of contractions • Elevation of presenting part • Scar pain • Bleeding / shock

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

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

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

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