CAESAREAN SECTION

 Caesarean section is delivery of the fetus usually through a trans-abdominal low segment incision of the uterus

Definition:- Abdominal delivery of body by laparotomy & section of uterus \after 28th week of pregnancy

Incision on the abdominal & uterine wall

Indication:-

Failure to progress in labour

Mal – presentation (Breech, brow, transverse lie)

Fetal distress

Cephalo-pelvic disproportion (CPD)

Pre-eclampsia

Growth retarded uterus

Obstructed labor

Pre- mature rupture of membrane

Post cesareans pregnancy

APH

High risk pregnancy

Time of Operation:-

(1) Elective: - C.S is done as pre-planned

Eg. During late pregnancy

Repeat CS

High risk pregnancy

Time of operation 39-40 week of pregnancy

Emergency:- C.S is done during late Preg. & labor on emergency high risk indigestions.

Eg. Obstructed labour

Severe APH

Cord prolapsed

Fetal distress

Time of operation at any duration of pregnancy at any part of day & night

Types:-

(1) Lower segment cesareans section (LSCS):- Fetus is extracted from uterus by making incision on lower uterine segment through laparotomy

- Incision is made 3 cm above the symphysis pubis

- Incision is 11.25 c

(2) Classical & Upper segment cesarean section (USCS):-

Done by giving incision in upper uterine segment through laparotomy

Incision is 12.5 cm

(3) Cesarean hysterectomy:- This is an abdominal delivery of the body by cesarean section followed by hystectomy

(4) Extra peritoneal lower segment operation:- Not done

Complication:-

(1) Immediate:- 

Hemorrhage

Pyrexia

Card infection

Septic shock

Pulmonary Embolism

Anesthetic problem

(2) Remote:-

Menstrual disorder

Chronic pelvic pain 

Pelvic adhesion

Anemia

Scar rupture

Infertility

V.V.F

Pre operative preparation:-

Obtain written consent from guardian/parents.

Anesthesia & blood transfusion should be kept ready

Antacid (Sodium citrate) Should be administered orally before sending her to OT to neutralize existing gastric juices

Empty the stomach

Catheter sating to empty bladder

Tie identification band

Check FHS regularly

Scrub Abdominal with soap & water

General/local Anesthesia

Wash abdomen with 75% provide Iodine Solution.

Take help of neonatologist

Post Operative Case:- 1st 24 hrs.

Observe Pt for 6-8 hrs.

Monitor vitals, Vaginal bleeding & behavior of uterus

NS or RL infusion (2 to 2.5 l)

Blood transfusion

Antibiotics Pethidine  HCL 75-100 my

Analgesic’s

Ambulation

Start breast feeding

Inj. Methargin 2mg IV

2nd day:-

Oral feeding in from tea, juice electrolytes or water etc.

Note the condition of bowel

Encourage deep breathing

3rd days:-

Light Solid diet – khichdi/dahlia

Start breast feeding

5th days:-

Remove stitches

Transverse day 5 , longitudinal day 6 health education