Cesarean Section - CS

Presented by :Jaber Manasia

Cesarean section

Procedure

Preoperative preparation for CS

• Full blood count and haemoglobin

• Cross match

• Routine ultrasound before CS

• Urinary catheter use at CS

• Preoperative shaving

• Coagulation Profile PT, PTT, fibrinogen

3

• All patients transferred to theatre must be in the left lateral position (to prevent ‘supine hypotension’ and fetal distress) ;

• Premedication with antacid is standard;

• In the theatre or operating room must also be kept in the left lateral tilt position until after delivery;

• Thromboprophylaxis should be given for all patients and prophylactic antibiotics should be given.

Anesthesia

• A woman may be given spinal anesthesia for the procedure, or she may have a general anesthesia.

• Spinal anesthesia is similar to an epidural, where a needle is inserted into the fluid that surrounds the spinal cord so that there is no sensation from the chest down.

• Some women may require general anaesthesia during the caesarean, & This is sometimes necessary when the baby must be delivered quickly

Anesthesia

Surgical technique for cs

Abdominal-wall incision

• The vertical incision should be performed in the midline extending form just below the umbilicus to a point approximately 2 cm above the symphysis

• The transverse (pfannenstiel) incision should extend transversely for approximately 15cm at a point 2 cm above the symphysis

Vertical VS. Transverse

FasterFaster SlowerSlower

More exposureMore exposure Less exposureLess exposure

less attractiveless attractive Cosmetically Cosmetically more attractivemore attractive

High possibility High possibility of dehiscenceof dehiscence

Low possibility Low possibility of dehiscenceof dehiscence

Uterine incisionLow transverse incision

• This is the most common uterine incision

• It has much less bleeding than the classical incision

• It heals better, and less

likely of dehiscence

Uterine incisionLow transverse incision

•It is very important to make the uterine incision large enough to allow delivery of the head and trunk of the fetus without tearing or cut the uterine arteries and veins that course through the lateral margins of the uterus.

Uterine incisionLow transverse incision

• If the placenta is encountered in the line of incision, it must be either detached or incised. When the placenta is incised, fetal hemorrhage may be severe; thus, delivery and cord clamping should be performed as soon as possible in such cases

Delivery of the Infant

• In a cephalic presentation, a hand is slipped into the uterine cavity between the symphysis and fetal head, and the head is elevated gently with the fingers and palm through the incision, aided by modest transabdominal fundal pressure

Delivery of the Infant

Delivery of the Infant

•To minimize fetal aspiration of amnionic fluid, nose and mouth are aspirated with a bulb syringe before the thorax is delivered. The shoulders then are delivered using gentle traction plus fundal pressure

•The rest of the body readily follows.

Delivery of the Infant

•After the shoulders are delivered, an intravenous infusion containing about two ampules or 20 units of oxytocin per liter of crystalloid is infused at 10 mL/min until the uterus contracts, after which the rate can be reduced.

Delivery of the Infant

• After delivery of the baby the cord is clamped

• the infant is given to the team member who will conduct resuscitative efforts as needed

• The uterine incision is observed for any excessive bleeding sites.

Placental delivery

• The placenta is then delivered unless it has already done so spontaneously.

• Or by manual removal .

• Fundal massage, begun as soon as the fetus is delivered.

Repair of the Uterus

•The uterine incision is then closed with one or two layers of continuous 0 or number 1 absorbable suture

•Rarely done nowadays

•More bleeding

•Worse healing, and more likely of dehiscence

Uterine incisionClassical (upper segment) incision

Caesarean Hysterectomy

Caesarean section and hysterectomy are sometimes performed at the same time, e.g. where there is uterine rupture, placenta accreta, uncontrollable postpartum haemorrhage, and in the cases of cervical malignant disease.

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