Caesarean Section

Caesarean Section

Caesarean section is an operative procedure in which the fetus is delivered through a surgical incision in the maternal abdominal wall and uterus. The primary goal of caesarean delivery is the preservation of the life and well-being of both mother and fetus.

There are two major types of caesarean section: the lower segment and classical caesarean section.

A. The lower segments caesarean segment – the skinincision is made horizontally, suprapubic called a ptannenstiel incision or the "bikinicut” and incision is made in the lower segment of the uterus after about 32 weeks of gestation and is less muscular that the upper segment of the uterus. Since skin incision is low it is latter hidden by pubic hair.

Advantage

This heals more rapidly and success fully 

Blood loss is minimal, few post delivery complications occur The incision is easy to repair.

Less chance of rupture from the uterine scar in future pregnancies.

Disadvantage- the procedure takes larger to perform andthus is not useful in an emergency.

B. Classical caesarean section is a vertical mid line incisionis made in the skin and also in to the wall of the body of the uterus.Indication for this approach are gestation of less than about 32 weeks. 

Indication- preferred when there are abdominal adhesionsfrom previous surgery

·        when the fetus is in a transverse lie

·        In an emergency delivery

Disadvantage- blood loss is increased

There is a greater chance of rupture of the uterine scar in subsequent pregnancies and labour

Indications for cesarean section

Elective caesarean section- Decision to deliver the baby bycaesarean section has been made during the pregnancy and before the onset of labour.

Definite indications include

·        Cephalopelvic disproportion

·        Major degrees of placenta praevia

·        Multiple pregnancy with three or more fetuses

·        Malpresentation

Possible indications include:

·        The primigravida and often the multigravida with a breech presentation

·        Moderate to severe pregnancy induced hypertension

·        Diabetes mellitus

·        Intrauterine growth retardation

·        Antepartum hemorrhage

·        Previous caesarean delivery

Emergency caesarean section- is performed when adverseconditions develop during labour.

Definite indications include:

·        Cord prolapse

·        Uterine rupture (dramatic) or scar dehiscence (may be less acute)

·        Cephalo pelvic disproportion diagnosed in labour

·        Eclampsia

·        Failure to progress in the first or second stage of labour

·        Fetal distress, if delivery is not imminent

Contra indications

·        The presence of dead fetus

·        An immature fetus that could not survive out side the uterine environment.

Complications

·        The immediate complications are hemorrhage from the placental site, or the wound; gut distention and ileus; infection; pulmonary collapse and thrombo embolism.

·        The late complications are abdominal hernia, intestinal obstruction due to adhesions, and vague abdominal pain.