CESAREAN SECTION

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CESAREAN SECTION
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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

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INDICATIONS FOR ELECTIVE CS

• Known CPD
• Fetal macrosomia gt 4500 gm
• Placenta previa
• HIV
• Active herpes
• Repeat CSgt2

• Uterine surgery eg. Hystrotomy, myomectomy
• Severe IUGR
• Breech
• Multiple pregnancy
• Transverse lie
• Ca of the Cx/ Tumor obstructing the birth canal

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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

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TIMING OF ELECTIVE CS

• For maternal interest ? no choice
• For fetal interest ?consider maturity fetal
  condition
• Usually at 38 wks

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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

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• 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

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COMPLICATIONS

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

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COMPLICATIONS

• POSTOPERATIVE
• Gaseous distension
• Paralytic ileus
• Wound dehiscence infection
• Infectins ? UTI, pulmonary
• DVT pulmonary embolism
• Death
• Vesico uterine fistula

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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

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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

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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

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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