Previous cesarean section

Previous cesarean section

1. Previous Cesarean S ection Dr P.Pallavee

2. A 28 yr old G2P1L1 at 39 wks gestation with history of previous caesarean section comes to OPD with complaints of pain abdomen. Identify the risk in the patient.

3. Objectives Define the terms Caesarean section/ERCS/TOLAC Describe the effect of prior caesarean section on present pregnancy . Assess the integrity of scar to decide mode of delivery.

4. Understand the terms….. Caesarean section [ LSCS/ CLASSICAL] Post caesarean pregnancy Primary caesarean section ERCS[ Elective repeat caesarean section] TOLAC/VBAC

5. What is the risk? Abortion Preterm labour Placenta praevia Adherent Placenta PPH Peripartum hysterectomy Scar rupture

6. Which scar is sound?

7. LSCS CLASSICAL Apposition More perfect Difficult to appose as thicker musculature Healing Part of uterus remains inert Part contracts/retracts Stretching effect Along the line of scar At right angles Scar rupture 0.2% 4-9% Mortality less more

8. Mode of delivery Once a caesarean always a caesarean? Classical caesarean/ hysterotomy ERCS LSCS ERCS? TOLAC? ASSESS SCAR INTEGRITY

9. Integrity of scar Factors to consider : Previous operative notes Defect in scar in inter-pregnancy interval Short inter-pregnancy interval Pregnancy complications[ twins/ polyhydramnios ] Previous vaginal delivery. Indication of previous CS Extension of the uterine incision Puerperal sepsis

10. Management of post caesarean pregnancy. Manage as high risk Elective hospitalisation 36 wks- classical CS/ hysterotomy 38 wks-LSCS Mode of delivery Classical CS/ other extensions– ERCS[ 38 wks] LSCS– Individualise ----ERCS at 39 wks ---- TOLAC[spontaneous/induction]

11. References DC Dutta textbook of obstetrics.

12. THANK YOU.