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CESAREAN SECTION

CESAREAN SECTION. 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 Anterior PP & abnormally vascular lower segment

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CESAREAN SECTION

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  1. CESAREAN SECTION

  2. 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 • Anterior PP & abnormally vascular lower segment • Mother dead & rapid delivery is required • Preterm fetus in breech pres

  3. Known CPD Fetal macrosomia> 4500 gm Placenta previa HIV Active herpes Repeat CS>2 Uterine surgery eg. Hystrotomy, myomectomy Severe IUGR Breech Multiple pregnancy Transverse lie Ca of the Cx/ Tumor obstructing the birth canal INDICATIONS FOR ELECTIVE CS

  4. INDICATIONS FOR EMERGRENCY CS • Severe PET • Abruptio placntae • Fetal distress • Failure to progress in the first stage of labour • Cord prolapse • Obstructed labour • Failed induction • Malpresentation brow, mento post, shoulder & compound presentations, breech • Compromised fetus secondery to DM, HPT, isoimmunization • APH

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

  6. Nursing interventions Before Emergency CS • Explain to the Pt & husband & obtain consent • Inform anesthetist, OR staff, pediatrician • 100% oxygen mask in case of fetal distress • Transfer to the theatre, IV , take blood for Hb, x-match 2 U of blood • Catheterize the bladder

  7. Prophylactic antibiotics ↓↓ incidence of infection • Inform pediatrician if the mother had opiates in the last 4 hrs • Halothane should not be used uterine relaxation & bleeding • Preferable to use spinal or epidural anaethesia

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

  9. COMPLICATIONS POSTOPERATIVE • Gaseous distension • Paralytic ileus • Wound dehiscence & infection • Infectins UTI, pulmonary • DVT & pulmonary embolism • Death • Vesico uterine fistula

  10. 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

  11. MODE OF DELIVERY IN NEXT PREGNANCY CRITERIA FOR VBAC;(vaginal birth after cessarian) • 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

  12. 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

  13. 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

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