This is an operation by means of which the fetus is delivered through an incision on the abdominal wall and uterus after 28 weeks of gestation. A similar procedure before 28th week is referred to as hysterotomy.
· Cephalo-pelvic disproportion/contracted pelvis
· Obstructed pelvic tumour, fibroid.
· Stenosis of the vagina- Gynaetresia
· Major placenta praevia
· Failed induction of labour, trail of labour or failure to progress
· Fetal and maternal distress.
· Severe pre-clampsia/Pregnancy induced hypertension.
· Previous successful repair of VVF.
· Previous two or more caesarean section.
· Abnormal presentations: Breech, brow, face shoulder presentations.
· Elderly primigravida with minor problems.
· Abnormal uterine action.
· Medical conditions – Diabetes, nephritis etc.
· Placenta insufficiency.
· Bad obstetric history
· Locked twins/conjoined twins.
· Uterine rupture.
This is the operation which is planned because the need is apparent before labour. The woman is admitted a day or two prior to operation at 38th week or at term.
The abdomen is opened through a midline or paramedia incision from above the level of the symphysis pubis to about 2.5cm below the umbilicus. Sometimes Pfannenstiel Or Bikini – l ine incision (transverse line) is preferred by some for cosmetic reason.. The danger of damage to the bladder is high in on inexperienced hands.
Classical Caesarean Section (upper segment Caesarean Section) aparamedia incision is made (16cm) extending from slightly above the umbilicus is used when the fetus lies transversely or Placenta praevia is anterior 32 weeks before the lower segment is formed. Healing process is delayed because the contraction of the upper segment in Puerperium and rupture may occur with subsequent pregnancies. The woman must always be delivered by C/S. Danger of damage to the bladder is low.
· Slight bleeding and little damage to the uterine musculature.
· Formation of adhesion is reduced and loss intestinal obstruction.
· Infected case hardly lead to peritonitis because the uterus is on its own.
· The tranquility of the lower segment favours good healing which decrease the risk of subsequent rupture of the scar. Pre-Operative preparation and post Operative care are similar to that for any other major abdominal operation.