L2: Cesarean Section Flashcards
Def of CS
Incidence of CS
Types of CS
- According to operative method
- According to time of performing
- According to number of CS
Types of CS
- According to operative method
Types of CS
- According to time of pregnancy
Types of CS
- According to number of CS
1) 1ry CS: 1st CS.
2) Repeated CS: 2nd, 3rd, 4th, 5th, …
Indications of CS
Indications of CS
- Faults in power
Uterine underactivity or overactivity.
Indications of CS
- Faults in passages
Indications of CS
- Faults in passengers
1) Undeliverable presentations (see obstructed labor).
2) Large sized fetus (macrosomia).
3) Congenital anomalies (as hydrocephalus & conjoined twins).
4) Locked twins.
5) Placental site Hge (placenta previa or placental abruption).
6) Prolapsed pulsating cord with incompletely dilated cervix.
Indications of CS
- Diseases of mother
1) Severe hypertensive disorders.
2) DM (with polyhydramnios, preeclampsia, macrosomia, IUGR or bad obstetric history).
3) Severe heart disease (cases with restricted COP).
Indications of CS
- Fetal Condition
1) Fetal distress.
2) Postmaturity.
3) Rh isoimmunization.
4) Vasa previa.
5) Precious baby (elderly primigravida, history of infertility or bad obstetric history).
6) Habitual IUFD during last few weeks of pregnancy (CS is done 1 week earlier than date of death of previous fetus).
CI of CS
General Steps of CS
- US
- Perparation of Patient
- Actual Technique
General Steps of CS
- US
To
- Confirm fetal viability & maturity
- Exclude malformations & multifetal pregnancy
- Localize placental site.
General Steps of CS
- Preparation of patient
General Steps of CS
- Tecnique of USCS
Tecnique of USCS
- Abdominal Incision
Paramedian incision.
Tecnique of USCS
- centralize the uterus
- to correct dextrorotation & dextroposition.
Tecnique of USCS
- uterine incision
- Anterior central midline subumbilical incision vertical incision (in least vascular area) is done in peritoneum, muscle layer & decidua till amniotic sac or placenta appears
(if placenta is anterior, either cut through it or sweep it off uterus to reach amniotic cavity).
Tecnique of USCS
- Rupture the amniotic membrane
…
Tecnique of USCS
- Deliver fetus
Grasp foot of fetus & deliver it as breech.
Tecnique of USCS
- Clamp & divide umbilical cord
…
Tecnique of USCS
- Deliver placenta & membranes
…
Technique of USCS
- Explore uterine cavity
for remnants or congenital anomalies.
Technique of USCS
- Ensure that cervix is dilated
to allow passage of lochia.
Technique of USCS
- Suture the uterine incision
(in 2 layers)
a) Interrupted sutures in deep muscle layer beneath decidua.
b) Interrupted layer taking peritoneum & muscle layer.
Technique of USCS
- Abdominal toilet
…
Technique of USCS
- Close abdominal wall in layers
…
Technique of Transverse LSCS (Munro kerr)
Technique of Transverse LSCS (Munro kerr)
- abdominal incision
- Pfannenstiel incision or midline subumbilical incision.
Technique of Transverse LSCS (Munro kerr)
- centralize the uterus
- & put Doyen’s retractor in lower abdominal incision to retract bladder & protect it.
Technique of Transverse LSCS (Munro kerr)
- Uterine Incision
- Rupture the amniotic membrane
a) Transverse incision in peritoneum of LUS below white line & dissect upper & lower flaps together with bladder from underlying LUS.
b) Transverse incision in LUS (Munro Kerr’s incision) & incision is enlarged by either 2 index fingers or by scalpel or scissor
…..
Technique of Transverse LSCS (Munro kerr)
- Deliver fetus
Technique of Transverse LSCS (Munro kerr)
- Clamp & Divide umbilical cord
….
Technique of Transverse LSCS (Munro kerr)
- Deliver placenta & Membrane
….
Technique of Transverse LSCS (Munro kerr)
- explore uterine cavity
for remnants or congenital anomalies.
Technique of Transverse LSCS (Munro kerr)
- Ensure that cervix is dilated
to allow passage of lochia
Technique of Transverse LSCS (Munro kerr)
- Suture the uterine incision
(in 3 layers)
- Continuous sutures in muscle wall but not including decidua.
- Interrupted inverted Lambert’s sutures in muscle to cover 1st layer.
- Closure of peritoneum.
Technique of Transverse LSCS (Munro kerr)
- abdominal toilet
….
Technique of Transverse LSCS (Munro kerr)
- Close abdominal wall in layers
….
Indications of USCS
Advantages of USCS
Disadvantages of USCS
Advantages of Transverse LSCS
Disadvantages of Transverse LSCS
Def of Cesarean hystrectomy
CS & removal of uterus at the same operation.
Indications of Cesarean hystrectomy
postmortem / Perimortem CS
- Time Allowed for delivery
- Postmortem CS is done within 10 minutes of maternal death (after taking consent) to save life of living fetus (by rapid extraction of fetus by USCS under maternal cardiac massage & lung oxygenation).
postmortem / Perimortem CS
- Indications
Perimortem CS is done in cases of brain death & post-arrest syndrome.
Complications of CS
Complications of CS
- Immediate
Complications of CS
- Remote
Prognosis of CS
Indications of CS with Sterialization
How to Reduce Rate of CS?
How to Reduce Rate of CS?
- Limit Indications
How to Reduce Rate of CS?
- Labor
How to Reduce Rate of CS?
- Fetal Distress
How to Reduce Rate of CS?
- Educational Program for pregnant Lady
…
Introduction to VBAC
Prerequisities of VBAC
CI of VBAC
Complications of VBAC
Prognosis of VBAC
Success Rate of VBAC
Factors Predicting Successful VBAC