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    Caesarean Section (C/S) : by DR G. Saungweme

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    daniel
    The document discusses caesarean section (C/S) rates, indications, types, procedures, complications, and risk factors. It notes that worldwide C/S rates have increased in recent decades, though rates in sub-Saharan Africa have traditionally been below 5%. Reasons for increased C/S include older maternal age, electronic fetal monitoring, obesity, and litigation concerns. Complications can include hemorrhage, injury to adjacent organs, infection, and in rare cases death. Careful patient preparation and prophylactic antibiotics can help reduce risks.

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    Caesarean Section (C/S) : by DR G. Saungweme

    Uploaded by

    daniel
    51 views23 pages
    The document discusses caesarean section (C/S) rates, indications, types, procedures, complications, and risk factors. It notes that worldwide C/S rates have increased in recent decades, though rates in sub-Saharan Africa have traditionally been below 5%. Reasons for increased C/S include older maternal age, electronic fetal monitoring, obesity, and litigation concerns. Complications can include hemorrhage, injury to adjacent organs, infection, and in rare cases death. Careful patient preparation and prophylactic antibiotics can help reduce risks.

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    CAESAREAN SECTION

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    The document discusses caesarean section (C/S) rates, indications, types, procedures, complications, and risk factors. It notes that worldwide C/S rates have increased in recent decades, though rates in sub-Saharan Africa have traditionally been below 5%. Reasons for increased C/S include older maternal age, electronic fetal monitoring, obesity, and litigation concerns. Complications can include hemorrhage, injury to adjacent organs, infection, and in rare cases death. Careful patient preparation and prophylactic antibiotics can help reduce risks.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    51 views23 pages

    Caesarean Section (C/S) : by DR G. Saungweme

    Uploaded by

    daniel
    The document discusses caesarean section (C/S) rates, indications, types, procedures, complications, and risk factors. It notes that worldwide C/S rates have increased in recent decades, though rates in sub-Saharan Africa have traditionally been below 5%. Reasons for increased C/S include older maternal age, electronic fetal monitoring, obesity, and litigation concerns. Complications can include hemorrhage, injury to adjacent organs, infection, and in rare cases death. Careful patient preparation and prophylactic antibiotics can help reduce risks.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    CAESAREAN SECTION (C/S)

    By

    DR G. SAUNGWEME
    Incidence
     Incidence has increased worldwide, e.g. in
    USA, c/s rates increased from 4.5% in 1970 to
    31.8% in 2007.
     In other countries, and private hospitals, it is

    as high as 50 - 60%
     Reasons for increase are varied
     The ideal c/s ratio for primups, low risk

    women is 15%.
     In sub-Saharan African a low C/S rate (< 5%)
    has been reported for many years
     This represents inadequate access to medical

    services in economically deprived countries


    and these have high MMR and PNMR
     Our rate is between 15 – 20%
    Reasons for ↑ in c/s rate
     Mostly primups having c/s because women are having
    fewer children
     Average ↑ in maternal age is older, esp primup ♀
    increases risk of c/s
     Electronic fetal monitoring is rampant and is associated
    with ↑ in c/s rate
     Less forceps, vacuum
     ↑rates of induction of labour esp. for primups
     ↑ obesity, which ↑ rate of c/s
     VBAC had decreased
     Choice
     Litigation
    Advantages of c/s

     Avoidance of complications of labour and


    delivery such as:
    ◦ Birth injury to mother and baby
    ◦ Birth asphyxia associated with prolonged labour
    ◦ Complications of neglected, prolonged labour,
    such as endometritis
    Disadvantages of c/s

     Maternal mortality is 4 - 5 times higher


     Morbidity is also higher (endometritis, wound
    sepsis, chest infection, thrombophlebitis)
     Emergency caesar has 2 x as many
    complications as elective c/s
    Indications of c/s (Maternal Indications)
     Life-threatening uterine haemorrhage
     Eclampsia or imminent eclampsia
     Major placenta praevia or vasa praevia
     Space-occupying pelvic lesion
     Gross pelvic contraction
     Previous successful operation for urinary incontinence
     Cervical carcinoma
     Serious medical illness
     Bearing-down efforts contraindicated, e.g. cerebral aneurysm
     Previous classical caesarean section
     Previous lower segment caesarean section, plus another
    significant factor
     Uterine rupture
     Maternal preference
    Indications of c/s (Fetal Indications)
     Suspected fetal distress
     Presentation or prolapse of the umbilical
     cord
     Brow or mento-posterior face presentation
     Transverse or oblique lie
     Breech presentation unsuitable for vaginal delivery
     Prematurity
     Multiple pregnancy, particularly high
     multiples
     Macrosomia
     Certain fetal anomalies
     Fetal thrombocytopenia
     Risk of fetal infection (e.g. herpes, group B streptococcal
    infection and HIV)
    Indications of c/s
    (Combined Fetal & Maternal Indications)

     Failure to progress in labour (absolute or relative


    cephalopelvic disproportion, or inadequate uterine
    action)
     Failed forceps or vacuum delivery
     Failed induction of labour
    Type of c/s
     Elective c/s:
    ◦ Pre planned c/s
    ◦ Usually done before labour commences
    ◦ Fewer complications compared to emergency because
     Proper patient preparation
     Anaesthesia under ideal conditions
     Less urgency, therefore more meticulous technique
     Intact membranes reduce risk of infection
     Risk of neonatal complications is reduced
    Type of c/s (cont.)

     Emergency c/s
    ◦ Done in labour if harzadous complications for
    mother or fetus develop
    ◦ Complication rates 2 times higher
    Skin incisions for caesarean section

    1. Subumbilical median 1

    2
    2. Pfannenstiel
    1
    Uterine Incisions
    Patient preparation (Nursing)

     Informed, written consent should be obtained.


     Commence an intravenous infusion of a balanced

    electrolyte solution. For regional analgesia, preload


    with 500-1 000 ml of Ringer's/ lactate.
     The bladder should be emptied. An indwelling

    catheter is useful, but not essential.


     Shaving of the lower abdomen and pubis (vulva and

    perineum) is not essential.


     Administer 30 ml antacid orally or 200 mg cimetidine

    IV one hour pre-operatively, to raise the gastric pH in


    order to reduce the risk of chemical pneumonitis in
    case of aspiration.
    Patient preparation (Nursing, cont.)

     If there is any doubt concerning an empty


    stomach, metoclopramide 10 mg IV, should be
    administered. Emetics should never be used, and
    a gastric tube is used only in exceptional
    circumstances.
     The patient should lie on her side pre-opera­
    tively (or at least at a 15° lateral tilt) to avoid
    supine hypotension.
     Monitor the fetal heart.
     Administer premedication as prescribed by the
    anaesthetist.
    Patient preparation (Physician)

     The physician's responsibilities are the following:


     FBC, U + Es and crossmatching of blood for possible

    blood transfusion (giving blood is necessary only in


    special cases).
     Making arrangements with the theatre, an

    anaesthetist, an assistant and, if deemed necessary,


    a paediatrician.
     The anaesthetist and paediatrician should be

    informed of:
    ◦ The indication for the planned operation
    ◦ The patient's general condition
    ◦ Any complicating disease and relevant special investigations
    Prophylactic antibiotics
     Routine prophylactic antibiotics reduce the
    risk of infection in both elective and
    emergency caesarean section
    Factors for complications during or after
    caesarean section
    Maternal
    1. Infection
    Operative and obstetric factors
     Active labour

     Prolonged rupture of membranes

     Poor/no progress, prolonged labour

     Meconium in the amniotic fluid

     More than 4-6 vaginal examinations during

     labour

     Internal fetal monitor

     Operating time> 60 minutes

     Blood loss> 800 ml, post-operative anaemia

     Obesity

     Low socio-economic status


    Factors for complications during or after
    caesarean section (cntd)

     Placenta Preavia
     Accreta
    Factors for complications during or after
    caesarean section

    Fetal
     Fetal distress
     Iatrogenic prematurity
    Complications

    (i) Anaesthetic (Mendelson’s syndrome)


    • During intubation
    • During operation
    • During reversal
    • In recovery
    (ii) Intra operative
    • Haemorrhage
    • Damage of adjacent tissues
     Bladder
     Ureter
     Bowel (due to adhesions)
    (iii) Post operative
    • Haemorrhage
    • Urinary retention
    • Paralytic ileus
    • Infection
     UTI
     Chest infection
     Wound sepsis
    • Burst abdomen
    • DVT
    • Pulmonary embolism

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