Repeat LSCS Flashcards
Caesarean delivery
Delivery of foetus after period of viability through an incision in the lower abdomen wall and intact uterus
Indications of LSCS
Absolute: malpresentation, previous full thickness myomectomy, CPD, vaginal septum, placenta previa, first twin non vertex position, cervical cancer, prolapsed cord
Relative: Severe pre- eclampsia and eclampsia, FGR, abnormal fetal Doppler
Recurrent: contracted pelvis
Prerequisites for VBAC
•Non recurrent indication for previous LSCS
•Post operative period uneventful
• interval more than 18m
•no induction of labour in VBAC
Advantages of LSCS and classical section
Scar rupture and dehiscence is less in LSCS
Scar heals better in LSCS
During second pregnancy the pressure is parallel to the scar
Complications of caesarean section
During surgery - anaesthesia complications, injury to head of fetus, haemorrhage and atonicity
Post operative- v, abdominal swelling, fever and wound infection
Indications for classical cesarean section
Cervical cancer, conjoint twins, fibroid in lower segment, large vessels in lower uterine segment
Post operative problems
Distension of abdomen, wound infection, uti, fever in peurperium ,foul smelling lochia
Scar dehiscence
Incomplete scar rupture - peritoneum intact
Signs and symptoms of uterine rupture
Symptoms of sudden give away
the patient is usually in tachycardia, shock,haematuria, hypotension
Uterine contour is lost
Suprapubic bulge
Foetal parts felt superficially and foetal heart will be absent
Fresh bleeding pv
Vbac
Vaginal birth after caesarean section can be tried if the scar thickness is more than 3.5mm in usg after 36-38 weeks
Prerequisites for vbac
Conducted in institutions with facilities for emergency c section
Counselling and informed consent
Non recurrent indication for previous LSCS
Previous post operative period uneventful
Interval more than 18m
In present pregnancy no complications
Spontaneous labour onset
Monitoring during vbac
Iv fluids to be given with wide bore needles
Solid diet should be avoided
Blood cross matching
First stage - monitor pulse fhr every 30 mins
Monitor progress of labour by partogram
Second - forceps or vaccum
Third- active line of management
Monitoring during vbac
Iv fluids to be given with wide bore needles
Solid diet should be avoided
Blood cross matching
First stage - monitor pulse fhr every 30 mins
Monitor progress of labour by partogram
Second - forceps or vaccum
Third- active line of management
