Caesarean Section

Caeserian section
Maternal Risk includes in C/S

 Wound infection
 Urinary tract infection
 Hemorrhage
 Paralytic lleus
 Bludder injury
 Thromboembolism and pulmonary embolism
 Peripartum hysterectomy
 Tiredness
 Backache
 Sleeping difficulties
 Depression and psychological effect
 Future risks , including

 Fertility issues
 Miscarriages,
 Abdominal adhesions, intestinal obstruction
 Uterine rupture
 Placental abruption
 Placenta previa
Risk of caeserian section for fetus or infant
Due to maternal cardiovascular changes and to maternal

1.
anaesthesia specially spinal anaesthesia baby may develop
cardiovascular disease.
Low APGAR score

2.
Relative fetal acidosis
3.
Respiratory distress including transient tachypnoea of
4.
newborn is increased x4 compared to vaginal birth
Indications of C/S
Definitive indication
P/H/O C/S
1.
Cephalopelvic disproportion
2.
Placenta previa
3.
Multiple pregnancy with three or more fetuses
4.
Possibly elective C/S indications include:
Moderate to severe preeclampsia

1.
A medical condition that means the woman should not
2.
be allowed to make exertion or push
Diabetes mellitus with macrosomic baby

3.
Severe intrauterine growth retardation
4.
Antepartum haemorrhage
5.
Malpresentation
6.
Breech presentation
7.
Certain fetal abnormality
8.
Previous predicted shoulder dystorsia and large fetus
9.
Active genital herpes
10.
Maternal HIV infection
11.
Pelvic tumours
12.
Previous repair operation in the perineum such as
13.
repaired vesicovaginal fistula, rectovaginal fistula
Emergency CS indications may include:
Anti partum hemorrhage

1.
Cord prolapsed
2.
Uterine rupture
3.
Caphalopelvic disproportion
4.
fetal distress
5.
Effects of C/S:
Short term risks:
Baby:
1. Altered immune development of the baby
2. Increased likelihood Allergy
3. Atopy
4. Asthma.
5. Reduced intestinal gut microbes
6. Obesity.
Mother:
1. Infection.
2. Abnormal uterine bleeding
3. Increased maternal morbidity & mortality. (Higher
than Vaginal birth)
Long term risks:

Baby:
1. Immune suppression (Frequent infections)
2. Less intelligence
Mother:
1. Ectopic pg
2. Ruptured uterus,
3. Abnormal placentation..
4. Uterine growth
5. still birth
6. Preterm birth.
CLASSICAL CAESAREAN SECTION
INDICATIONS
1. Access to lower uterine segment is restricted

because of adhesions
2. Lower segment approach is not possible due to
a. Anterior placenta praevia
b.Large fibroids in the lower uterine segment
c. Transverse lie (Dorso inferior positions)
d.Pregnancy with Carcinoma cervix
e. Post mortem caesarean section
Vaginal birth after caesarean section

Vaginal birth after caesarean (VBAC) is
sometimes termed a trial of labour after
caesarean (TOLAC) or trial of scar as the
previous caesarean sear of the uterus is
subjected to uterine contractions of the new
labour and birth.
The principle risk of VBAC for the mother is
rupture of the uterus.
Many years ago, there was a saying once a
caesarean always a caesarean but that was only
true when a classical or longitudinal upper
uterine incision was performed for the original
caesarean.
What is a Classical Caesarean?

The uterine incision is vertical, across both the
upper and lower segments of the uterus
When might a classical incision be used?
1. May be needed if baby very premature
2. Why? When is lower uterine segment

formed by?
3. When speed is essential?
4. When getting the baby out is

problematic?
What are the complications of a classical

caesarean scar?
1. Structure of the uterus means that scar is
more likely to dehisce or rupture in
subsequent labours & births
What is a Lower (Uterine) Segment
Caesarean Section (termed LUSCS or LSCS)
The uterine incision is transverse, into the
lower segment of the uterus.
What are the implications of a LUCS

caesarean scar?
This sort of scar is less likely to dehisce or
rupture in subsequent labours & births (less than
1% risk)
Remember: It is the incision into the uterus

not the incision in the abdominal skin, which
determines which sort of caesarean incision it
is.
Care of a woman who has previously had a
caesarean section:
Antenatal care of a woman who has had a

previous caesarean section:
1. History, history, history! The midwife

must get a full and good history so that
woman can be managed properly
2. Type of CS
3. Reason the caesarean performed
4. Post operative recovery
5. Any infections; wound healing
6. Complications
7. The information is vital to get clear
understanding of whether a her
8. Where does she plan to give birth?
9. She must go to hospital with facilities
for monitoring and an section if required as
an emergency
10. 1/3 of ruptured uterus occur in
pregnancy
Conditions associated with ruptured uterus in

labour:
The uterus is more likely to rupture in labour

when the following are present:
1. Use of syntocinon to induce /augment

labour
2. Fetal abnormality
3. Malpresentation
4. Overstimulation of the uterus
5. Trauma
6. History of placenta accrete
7. Obstructed labour
8. Difficult forceps
Care of a woman who has had a previous C/S:
1. Plan for the birth needs to be clear:
where will she go, how she will get there,
what support does she have.
2. She may need an Elective Caesarean if
any of
a.Twins
b. Placenta previa
c.classical caesarean scar
d. Type of CS uncertain
If a woman does not have any complications
then she must be encouraged to have a
VBAC. This is better for her and her baby.
Management of a woman in labour having

VBAC:
Timely detection and management of
complications are the keys to the prevention of
uterine rupture in labour.
Rupture of the uterus clinical presentations
are-
1. The amniotic sac and the baby may
rupture into the abdomen.
2. There is significant bleeding and shock
3. Fetal distress
4. May be life threatening if not promptly
managed
5. The baby may die or have Hypoxic
ischemic encephalopathy.
Dehiscence of uterine scar- clinical
presentations-
1. More common, but seldom results in
major maternal or fetal complications.
2. The membranes do not rupture and the
baby stays in the uterus.
3. Bleeding & shock are minimal
4. Baby usually survives
5. However prompt action is needed-
a. Baby may become compromised
b. Rupture may become worsen
Recognition of dehiscence of uterine scar:
1. Abnormality in fetal heart rate is the
strongest indicator. Major sign- fetal distress
2. This occurs in55-87% of uterine rupture
events
3. Vaginal bleeding
4. Continuous severe abdominal
pain( Separated from contractions)
5. Shock
6. Contractions may stop
Management:
1. Urgent C/S is required
2. All means take to resuscitate the woman
and treat the shock on the way to having an
emergency C/S.
Management of vaginal birth after C/S:
1. Avoid induction of labour
2. Try to avoid a large baby
3. Appropriate birth unit staff and facilities
4. Woman to be seen as soon as possible in
labour, as do not want a prolonged labour
5. High risk labour- doctor should be
involved
6. Usually a time frame is suggested(e.g-
birth within 8 hours of established labour)
7. Avoid augmentation of labour or use
only with great care
8. Must closely monitor maternal and fetal
wellbeing
9. Must closely monitor progression of
labour
10. Second stage timeframe: let the baby
descend spontaneously and shorter period of
pushing (do not allow prolonged second
stage)
11. Nothing by mouth- I/V fluid only
12. Keep doctor and seniors informed in every
stage.

Caesarean Section

Uploaded by

Copyright:

Available Formats

Caesarean Section

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Caesarean Section

Uploaded by

Copyright:

Available Formats

Caeserian section

Maternal Risk includes in C/S

 Future risks , including

Due to maternal cardiovascular changes and to maternal

Low APGAR score

Moderate to severe preeclampsia

Diabetes mellitus with macrosomic baby

Emergency CS indications may include:

Anti partum hemorrhage

Long term risks:

CLASSICAL CAESAREAN SECTION

1. Access to lower uterine segment is restricted

Vaginal birth after caesarean section

What is a Classical Caesarean?

1. May be needed if baby very premature

2. Why? When is lower uterine segment

3. When speed is essential?

4. When getting the baby out is

What are the complications of a classical

What are the implications of a LUCS

Remember: It is the incision into the uterus

Antenatal care of a woman who has had a

1. History, history, history! The midwife

Conditions associated with ruptured uterus in

The uterus is more likely to rupture in labour

1. Use of syntocinon to induce /augment

Management of a woman in labour having

You might also like