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CESAREAN SECTION CS

CESAREAN SECTION CS. CESAREAN SECTION Cs. Ghadeer Al- Shaikh , MD, FRCSC Assistant Professor & Consultant Obstetrics & Gynecology Urogynecology & Pelvic Reconstructive Surgery. TYPES OF CS. Lower segment CS Classical CS. Indications for classical CS.

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CESAREAN SECTION CS

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  1. CESAREAN SECTION CS

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

  3. TYPES OF CS • Lower segment CS • Classical CS

  4. Indications for classical CS • 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

  5. Repeat CS Placenta previa VV fistula repair HIV (poor controlled) Active herpes Fetal macrosomia> 4500 gm 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

  6. INDICATIONS FOR EMERGRENCY CS • 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 2ry to DM, HPT, isoimmunization

  7. TIMING OF ELECTIVE CS • Usually at 38-39 wks

  8. 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 20 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

  9. 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

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

  11. COMPLICATIONS POSTOPERATIVE • Paralytic ileus • Wound dehiscence & infection • Infectins UTI, pnemonea • DVT & pulmonary embolism • Fistula • Death

  12. 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

  13. 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

  14. MODE OF DELIVERY IN NEXT PREGNANCY 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 Observe for • Progress • Fetal wellbeing • Maternal well being • Epidural • HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

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

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

  18. 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

  19. 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

  20. 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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