caesarean section.pptx for nursing students

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1. CESAREAN SECTION

2. DEFINITION It is an operative procedure whereby the fetuses after the end of 28 th week are delivered through an incision on the abdominal and uterine walls.

3. INCIDENCE The incidence of cesarean section is steadily rising C-section rate in India – 17.2% was higher than the WHO-recommended limit

4. INCIDENCE Kerala 35.8 to38.9% from 2015-16 to 2019-20 Urban-Rural difference of caesarean section deliveries in 2019-20 is 39.1 & 38.7 respectively

5. INDICATIONS

6. ABSOLUTE INDICATIONS Vaginal delivery is not possible . Central placenta previa Contracted pelvis Pelvic mass causing obstruction Advanced carcinoma cervix Vaginal obstruction

7. RELATIVE INDICATIONS Vaginal delivery is possible but risks to the mother and/ or to the baby are high Cephalopelvic disproportion Previous cesarean delivery

8. RELATIVE INDICATIONS Non-reassuring FHR (fetal distress) Dystocia – Power, Passage, Passenger Antepartum hemorrhage Malpresentation

9. RELATIVE INDICATIONS Failed surgical induction of labor, Failure to progress in labor Bad obstetric history Hypertensive disorders Medical-gynecological disorders

10. COMMON INDICATIONS PRIMIGRAVIDAE Failed indication Fetal distress (non- reassuring fetal FHR)

11. COMMON INDICATIONS Cephalo pelvic disproportion (CPD) Dystocia Malposition and malpresentation

12. COMMON INDICATIONS MUTIGRAVIDAE Previous Caesarean delivery Antepartum haemorrhage Malpresentation (breech, transverse lie).

13. TYPES

14. TYPES

15. ELECTIVE When the operation is done at a prearranged time

16. EMERGENCY When the operation is performed due to obstetric emergencies. An arbitary time limit of 30 minutes is thought to be reasonable from the time of decision to the start of the procedure.

17. TYPES

18. UPPER SEGMENT CS Also called Classical C.S. In this operation, the baby is extracted through an incision made in the upper segment of the uterus.

19. LOWER SEGMENT CS Also called LSCS In this operation, the extraction of the baby is done through an incision made in the lower segment through a trans peritoneal approach.

20. TYPES

21. PRIMARY CS The first operation performed on a patient

22. REPEAT CS When the operation is performed in subsequent pregnancies, it is called Repeat Cesarean Section.

23. TYPES

24. TRANSPERITONEAL The ordinary operation where the peritoneal cavity is opened before incising the uterus

25. EXTRAPERITONEAL The peritoneal cavity is not opened and the lower uterine segment is reached either laterally or inferiorly by vesico -uterine pouch . It is indicated in case of chorioamnionitis

26. LOWER SEGMENT CESAREAN SECTION (LSCS) PREOPERATIVE CARE INTRAOPERATIVE CARE POSTOPERATIVE CARE

27. PREOPERATIVE CARE Admission Investigations and arrange blood Anaesthesia consultation Psychological and Spiritual preparation NPO

28. PREOPERATIVE CARE Enema Removal of Ornaments and Dentures Consent Abdominal preparation – Nipple to Mid thigh including Back

29. PREOPERATIVE CARE Catheterisation IV cannulation IVF OT dress Vital signs and FHS

30. PREOPERATIVE CARE Premedication Ranitidine (H2 blocker) 150 mg Metoclopramide (10 mg IV) Inform neonatologist and shift to OT

31. INTRAOPERATIVE CARE Anesthesia – Spinal, Epidural or General Position of the patient Antiseptic painting Incision on the abdomen

32. INTRAOPERATIVE CARE Packing Uterine incision Delivery of baby and Placenta Suturing

33. INCISION ON THE ABDOMEN Vertical or a Transverse skin incision. Vertical incision – Infraumbilical midline or paramedian . Transverse incision, modified Pfannenstiel is made 3 cm above the symphysis pubis.

34. INCISION ON THE ABDOMEN

35. PACKING The Doyen’s Retractor is introduced. The peritoneal cavity is now packed off using two taped large swabs. The tape ends are attached to artery forceps. This will minimize spilling of the uterine contents into the general peritoneal cavity.

36. UTERINE INCISION Lower segments transverse Lower segment vertical J incision Classical incision Inverted T incision

37. UTERINE INCISION

38. SUTURING A continuous suture is placed with chromic catgut No‘0’ or Vicryl taking deep muscles excluding the decidua . A second layer of interrupted sutures(1cm apart) using chromic catgut No.1 or Vicryl taking the entire depth of superficial muscles down to the first layer of suture.

39. SUTURING The third layer of continuous suture taking the peritoneum with the adjacent muscles using chromic catgut No ‘0’ and round bodied needle. Then abdomen sutured in layers

40. POSTOPERATIVE CARE First 24 hours: (Day 0) Preparation of post op bed Observation Fluid – IVF and Blood Transfusion

41. POSTOPERATIVE CARE First 24 hours: (Day 0) Oxytocics Prophylactic antibiotic Analgesics

42. POSTOPERATIVE CARE Day 1 Ambulation Oral feeding + IVF Removal of catheter Medications

43. POSTOPERATIVE CARE Day 2 Light solid diet Bowel care - Laxatives is given at bed time if the bowels do not move spontaneously.

44. POSTOPERATIVE CARE Day 5 or Day 6 The abdominal skin stitches are to be removed on the D-5 (in transverse) or D-6 (in longitudinal). Discharge on Day 7

45. Merits and demerits of lower segment operation over classical

46. COMPLICATIONS

47. INTRAOPERATIVE

48. INTRAOPERATIVE

49. POSTOPERATIVE

50. IMMEDIATE

51. IMMEDIATE

52. REMOTE Gynecological General surgical Future pregnancy

53. REMOTE GYNECOLOGICAL Menstrual excess or irregularities Chronic pelvic pain Backache

54. REMOTE GENERAL SURGICAL Incisional hernia Intestinal obstruction due to adhesions and bands.

55. REMOTE FUTURE PREGNANCY There is risk of scar rupture

56. FETAL Iatrogenic prematurity RDS