Caesarean section at Elobied teaching hospital .pdf

Caesarean section overview

1. Cesarean section
Dr Mohamed Elmalki

2. is a surgical procedure in which incisions are
made through a mother’s abdomen and uterus
to deliver one or more babies.
INTRODUCTION

3. Egypt
51.8 %
Dominician republic
58.1 %
Brazil
55.7 %
BIRTHS AROUND THE WORLD

4. 01
HISTORY
02
PROCEDURE
03
COMPLICATIONS
TABLE OF CONTENTS
Post cesarian care
INDICATIONS
0504 06
EMQs

5. HISTORY OF
CESAREAN SECTION

6. THE FIRST C-SECTION
●The name is said to derive from a
Roman legal code called Lex
Caesarea, which allegedly contained
a law prescribing that the baby be cut
out of its mother’s womb in the case
that she dies before giving birth.
●The derivation of the name is also
often attributed to an ancient story,
told in the first century AD by Pliny the
Elder, who claimed that an ancestor
of Caesar was delivered in this
manner.
●An alternative etymology suggests
that the procedure’s name derives
from the Latin verb caedere, to cut
●On March 5, 2000, Inés Ramírez
performed a Caesarean section on
herself and survived, as did her son.
She is believed to be the only woman
to have performed a successful
Caesarean section on herself.

8. The four major indications accounting for greater than 70 % of operations are:-
●Previous c section.
●Dystocia.
●Malpresentation .
●suspected acute foetal compromise.
Other indications, such as multifetal pregnancy, abruptio placenta, placenta praevia, fetal
disease and maternal disease are less common.
Absolute indications for recommending delivery by Caesarean section are few, almost all
indications are relative and there will be circumstances where Caesarean section may be
best for one woman but not another.
INDICATIONS:

9. DYSTOCIA
caused by uterine inertia, small
pelvic size, failure of cervical
dilation, and uterine torsion
SUSPECTED ACUTE FETAL
COMPROMISE
•Changes in the fetal heart rate.
•The fetus moves less for an extended period of time.
•Low amniotic fluid.
-causes and treatment.
01 02

10. ●Too frequent
contractions.
●Oligohydramnios.
●PIH.
●Preeclampsia.
●Long term pregnancy.
●Fetal growth
restriction.
●Placenta abruption.
●Placenta previa.
●Umblical cord
compression.
●Chronic conditions.
Causes:- Treatment:-
●Change position.
●oxygen through a
mask.
●Fluids through iv line.
●Medicine to slow or
stop contractions. Ex:
tocholytics.
●Amnioinfusion.

11. Fetal monitoring Macrosomia
Factors that may contribute to an
increase in the rates of C Section:
Maternal request
Low heart rate
or unusual
patterns
Genetics , gestational
diabetes,high pre
pregnancy
BMI,diabetes mellitus.

12. PROCEDURE?
Informed ConsentInstruments
Abdominal entry and
birth Placenta delivery and closure
mothers must understand what
is being planned and why.
Where possible, all women
must be educated in pregnancy
about C section and the
occasions under which it may
be urgently needed.

16. PRE-OPERATIVE
Laboratory
testing Anaesthesia foley catheter Fasting time
Rhesus immunization
A B

17. Make a transverse skin incision 2-3 cm below a line joining the anterior superior ischial spines. The
incision should be about 15 cm in length . Once the skin is incised, only cut the fat in the
midline.With the index fingers bluntly tear the fat and superficial fascia to the lateral edges of the
incision.Incise the rectus sheath transversely by making two cuts either side of the midline with a
scalpel. This incision is then extended on both sides by blunt dissection.then rectus muscles are
separated by blunt dissection.By looking at the peritoneum from inside you can identify the bladder.
Once the bladder is pushed down, move the Doyen into the space between the uterus
and the bladder so the bladder is kept out of the way while incising the uterus.The
initial incision should be a transverse incision about 3 cm in the midline made by a
scalpel. As you deepen the incision, feel how much tissue is remaining in between
every stroke of the knife.
If uterine incision-delivery interval exceeds 3-4 minutes, the risk for asphyxia of the
baby increases. Carefully insert your hand between the lower segment and the head.
Level the head out of uterus and abdominal incision through an upwards and
outwards manoeuvre. Rotate the shoulders to an anterior-posterior position. With the
assistant maintaining fundal pressure, deliver the anterior shoulder, and then the
posterior one. The rest of body is easely extracted from uterus.The umbilical cord is
then clamped in two places and cord cut between the two clamps.
C
B
A
DOCTOR'S STEP BY STEP

18. F
D
E
Closure of the uterus,fatty layer and skin
Remove the placenta by a steady gentle traction on the
cord. After removal of the placenta inspect it to ensure
that it is complete and there are no membranes
remaining and good uterine contraction is maintained.
At the end of the operation, fundal pressure is
applied to expel any clots. This will prevent old
blood later being confused with haemorrhage.

19. ●Bowel damage: may occur during a repeat
procedure or if adhesions are present from
previous surgery.
●Haemorrhage: a consequence of damage to
the uterine vessels, or consequence of uterine
atony or placenta praevia.to manage; these
range from bimanual compression, oxytocin
infusion, administration of prostaglandins,
conservative surgical procedures, but life
saving hysterectomy.
●Placenta previa: increases with increasing
parity.
●Urinary tract damage: increased after
prolonged labours.
●Cesarian hysterectomy.indication for
Caesarean hysterectomy is uncontrollable
maternal haemorrhage,atony,uterine rupture
and haemostasis.
Intraoperative complications: Postoperative complications:
●Infection and endometritis: prevention of any
surgical infection include careful surgical
technique, skin antisepsis and prophylactic
antibiotics should be administered to reduce
the incidence of postoperative endometritis
●Pulmonary emboile and DVT: administration
of prophylactic heparin.
●Psychological.

20. 01
FIRST WEEK
●painkillers to reduce any discomfort
●Start breastfeeding
●Move around as soon as possible
●Remove catheter after 12 hours of c section
●Clean and dry the wound everyday
02
SECOND WEEK
●Watch out for signs of infection
03
THIRD WEEK
●Stay mobile and do gentle activities .
POST CESAREAN CARE

21. TREATMENT OF THE BODY
Swelling and soreness
May remain for a 1
week or longer
Fluid discharge
Inhaled up to 6
weeks
nausea and vomiting
DVT

22. 0-6 7-12 13-24 END
HEALING TIMELINE

23. NORMAL BIRTH C. SECTION
Duration of labour Last up to 12-14 hours 45 minutes
Recovery time 2-6 weeks 6-8 weeks
Complications Perineal tears
Blood loss
Infection
Post partum depression
NORMAL BIRTH VS C. SECTION

24. Extended Matching Questions (EMQs)
a.) A nulliparous woman is exhausted. The cervix is fully dilated, the fetal head
is at the level of the spines, and is in a direct occipito-anterior (DOA) position.
The CTG is reassuring and the epidural anaesthesia is working well.
b.) A woman is reviewed after pushing for 2 hours. This is her second baby. The
first was delivered normally. The cervix is fully dilated, the station is -1 to spines
and per abdomen there is 2/5 of the head palpable. The position is right occipito-
transverse (ROT). The CTG is reassuring. No analgesia has been used in the
second stage.

25. c.) A nulliparous woman is reviewed for a pathological CTG in the second stage.
The cervix is fully dilated, the head is at +2 to the spines, the position right
occipito-anterior, and 0/5 of the head is palpable per abdomen, She has been
pushing for 30 minutes and is making good progress, but the decelerations are
becoming increasingly prolonged. She does not have an epidural.
d.) A nulliparous woman is reviewed for a bradycardia. The cervix is 9 cm dilated.
The head is direct OA, -1 station, the head is 2/5 palpable per abdomen, and she
has a well-working epidural. The bradycardia is now continuing for approaching
10 minutes.
e.) A nulliparous woman without an epidural is reviewed as she is requesting a
caesarean section. She has been pushing intermittently for half an hour, but she
is shouting and struggling when she is pushing. She is unsupported by her
partner and is frightened. The cervix is fully dilated, the head is at +2 to the
spines, direct occipito-anterior (DOA) position. The fetal heart rate is normal.

26. WORTH A THOUSANDS WORDS

27. Your dedication to nurturing the next generation
of medical professionals is truly commendable.
Unit II .
THANKS!