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OPERATIVE DELIVERY

OPERATIVE DELIVERY. Dr Jacqueline Woodman Consultant Obstetrician & Gynaecologist. Caesarean Section. A Caesarean section is a surgical procedure in which an incisions is made in the uterus to deliver one or more babies

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OPERATIVE DELIVERY

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  1. OPERATIVE DELIVERY Dr Jacqueline Woodman Consultant Obstetrician & Gynaecologist

  2. Caesarean Section • A Caesarean section is a surgical procedure in which an incisions is made in the uterus to deliver one or more babies • The first modern Caesarean section was performed by German gynaecologist Ferdinand Adolf Kehrer in 1881.

  3. Indications for Caesarean Section • Placenta praevia • Transverse lie • Previous classical Caesarean section • Obstructed labour • e.g. cephalo-pelvic disproportion, • failure to progress • Breech presentation • Abruptio placenta • Previous repeated Caesarean section • Fetal indications: • Congenital abnormality • e.g. severe hydrocehalus • Multiple pregnancy • e.g. first twin breech, triplets • Cord prolapse • Severe preterm IUGR • Maternal request e.g. tokophobia

  4. Planned Caesarean section will increase the following risks: http://www.nice.org.uk/nicemedia/live/13620/57166/57166.pdf • Maternal: • Longer hospital stay • Bleeding that requires a hysterectomy • Heart attack • Neonatal: • ICU admission

  5. Risks of Caesarean section • Neonatal: • Tansient tachypnoea of the newborn (TTN) • Injury to baby: 1-2 per 100 • Maternal: • Haemorrhage: 5 per 1000 • Hysterectomy: 8 per 1000 • Infection: 6 per 100 • Thrombosis: 4-16 per 10 000 • Visceral and / or vascular injury • Bladder injury: 1 per 1000 • Anaesthetic risks • Death: 1 per 12 000 • Future pregnancy: • antepartum stillbirth: 1-4 per 1 000 • Uterine rupture: 2-7 per 1000 • Placenta accreta: 4-8 per 1000 http://www.rcog.org.uk/guidelines

  6. Caesarean section: the procedure • Skin incision and entry? • Joel Cohen vs Phannelstiel: a 65% reduction in reported postoperative morbidity with the Joel-Cohen incision. • Incision of uterus: • transverse lower segment vs Classical • Closure of the uterus: • 1 vs 2 layer • Closure of the abdomen: • peritoneum, sheath, subcutaneous, skin http://apps.who.int/rhl/reviews/CD004453.pdf

  7. Classification of urgency of Caesarean section Maternal or fetal compromise: 1. Immediate threat to life 2. No immediate threat to moterh or baby 3. Requires early delivery No maternal or fetal compromise 4. At a time convenient to all

  8. Operative Vaginal Delivery Ventouse Forceps

  9. Indications for ventouse / forceps Failure to progress in second stage Fetal distress in second stage Maternal exhaustion Maternal conditions e.g. Heart conditions

  10. Conditions for a ventouse / forceps Fully dilated Maternal consent Station and position of fetal head known Bladder empty Lithotomy Analgesia

  11. Thank you

  12. References • NICE • CEMACH • RCOG

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