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1. Caesarean Section Presented By : Dr Shagufta Parveen Group D3 =

2. Caesarean Section: - A caesarean section is a surgical procedure in which incisions are made through the abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. - This procedure refers to the surgical delivery of a baby via the transabdominal route.

3. Incidence of Caesarean Deliveries In the UK and other high-income countries, 25% to 30% of births now occur via caesarean section. This represents a significant increase over historical rates, raising important questions about optimal delivery practices. A 1985 WHO conference noted no health benefits for caesarean section rates above 10-15%. More recent evidence suggests maternal and neonatal benefits with rates up to 19%. However, caesarean rates continue to rise significantly both nationally and internationally, often exceeding medically indicated levels. 25-30% UK Rate Current caesarean rate in high-income countries 10-15% WHO Guideline Recommended rate from 1985 conference 19% Recent Evidence Rate showing maternal and neonatal benefits

4. Classification of Caesarean Secti ion Caesarean sections are broadly classified as either elective (planned) or emergency procedures. Elective caesareans are scheduled in advance, often for medical reasons such as previous caesarean history, breech presentation, maternal medical conditions like pre-eclampsia, or maternal request. Emergency caesareans include all unscheduled procedures, performed urgently due to complications during labour or delivery. These are further classified into four categories based on urgency, from immediate life-threatening situations to planned deliveries. Category 1 Immediate threat to life of woman or foetus (e.g., placental abruption, umbilical cord prolapse, severe foetal distress) Category 2 Maternal or foetal compromise not immediately life-threatening but requiring prompt delivery (e.g., prolonged labour) Category 3 Early delivery needed but no immediate or serious maternal or foetal compromise Category 4 At a time to suit the woman and maternity services

5. Indications For C-section: Major indication accounting for
More then 70% of C-section operations . Previous c-section Malpresentation ( eg breech)
Failure to progress in labour precious pregnancy
Fetus compromise in labour Multiple pregnancies & Placental abruption
Placenta Previa Tocophobia Maternal conditions
HIV infection Other causes

6. Anatomy of Uterus Layers before reaching the fetus

7. Abdominal Incision Techniques The type of abdominal incision used during a caesarean section affects both the surgical approach and cosmetic outcome. Two main approaches are commonly employed, each with specific indications and considerations. Horizontal Incision (Pfannenstiel/Bikini) Most common type for planned lower segment caesarean sections. This involves a straight horizontal cut approximately 2cm above the symphysis pubis. Benefits include better cosmetic results and typically less post-operative pain. Vertical Incision A straight cut down the middle of the abdomen, typically used for classical caesarean sections or emergency deliveries. This approach allows for quicker access to the uterus and wider exposure when needed. Selection Factors The choice between horizontal and vertical incisions depends on urgency, maternal body habitus, previous surgical scars, and anticipated complications.

8. Types of Uterine Incisions The type of uterine incision used during a caesarean section significantly impacts outcomes and future pregnancies. Two primary approaches are used, each with specific indications and advantages. Lower Uterine Segment (LUS) This is the most popular technique, involving a transverse incision made across the lower part of the uterus near the bladder. It offers significant advantages: Less bleeding during surgery Easier to repair Reduced risk of adhesion formation Lower risk of future uterine rupture Classical (Vertical) A vertical incision made on the body of the uterus, necessary in certain conditions: Emergency deliveries Placenta previa Dense adhesions from previous C-sections Cancers of cervix or fibroids

9. Caesarean Section Procedure A caesarean delivery involves multiple carefully executed steps, beginning with proper preparation and ending with recovery care. Informed consent is essential before proceeding with this major surgical procedure. Preparation Patient receives anesthesia (epidural/spinal or general). The abdomen is cleaned, a sterile drape is placed, and a urinary catheter is inserted to keep the bladder empty during surgery. Incisions A horizontal (Pfannenstiel) incision is made just above the pubic hairline. Layers (skin, fat, fascia, muscles, peritoneum) are carefully opened to access the uterus, where a low transverse cut is typically made. Delivery After suctioning amniotic fluid, the baby is gently lifted out, the umbilical cord is clamped and cut, and the newborn is handed to the pediatric team for initial assessment. Closure The placenta is delivered, the uterus is stitched closed, and all abdominal layers are carefully sutured. The skin incision is closed with stitches or staples before recovery begins.

10. Post-Operative Care Proper post-operative care is essential for recovery after a caesarean section. This includes careful monitoring, pain management, and support for both physical healing and bonding with the newborn. Monitor Vital Signs Regular checks of blood pressure, pulse, bleeding, and uterine contraction to ensure normal recovery and detect complications early. Pain Management Administration of prescribed painkillers and encouragement of early mobilization to reduce discomfort and prevent complications. Wound Care Keeping the incision clean and dry while monitoring for signs of infection such as redness, swelling, or unusual discharge. Breastfeeding & Bonding Supporting early skin-to-skin contact and breastfeeding initiation despite the challenges of surgical recovery.

11. Common Complications of Caesarean Section While caesarean sections are generally safe, they carry risks of complications that require vigilant monitoring and prompt intervention. Understanding these potential issues is crucial for optimal patient care. Infection Risk of wound infection, endometritis (uterine infection), or urinary tract infection (UTI) following surgery. Excessive Bleeding Hemorrhage may occur due to uterine atony (failure to contract properly) or surgical injury to blood vessels. Blood Clots Increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) due to reduced mobility after surgery. Respiratory Issues Potential for pneumonia or respiratory complications, particularly with general anesthesia.

12. Thank You