Caeserian Section

CAESERIAN SECTION
PRESENTER SENIOR MIDWIFE MITI

TOPIC Caeserian section
GROUP September 2016
VENUE Classroom
TIME
HOURS Two hours

Specific objectives
Definition of caesarean section
This is the delivery of the baby through an incision in
the uterine and abdominal walls.
Types of operations
Elective Caesarean Section - This is planned before
hand
Emergency - This is an emergency operation, done to
save the life of the mother or baby.
Types of incisions
Classical Incision - This is not often performed. It is
sometimes needed if there is a placenta praevia or a
transverse lie. A longitudinal incision is made in the
uterus. This leaves a very weak scar in the uterus and
rupture in subsequent pregnancies is likely
Types of incisios cont.
Lower Uterine Segment Caesarean Section - here a
transverse incision is made in the lower segment of the
uterus.
Indications of performing a C/S
Cephalo pelvic disproportion
Malpresentation and abnormal lie e.g. Brow and
shoulder
Face presentation with a mentum posterior position.
Placenta praevia
Fetal distress when the cervix is not fully dilated
Maternal conditions e.g. eclampsia, diabetes mellitus,
PIH
Previous caesarean section for disproportion
Indications cont.
Previous classical caesarean section
Previous ruptured uterus
Failed trial of labour
Failed induction of labour
Cord prolapse in first stage of labour
Cord presentation
Elderly primigravidae with a breech presentation
Cervical dystocia
Preparing for an emergency C/S
The following should be carried out:
1. Explain to the woman why she needs the caesarean
section.
2. Make sure the partner is not excluded, and that he
is aware of his role.
3. Obtain consent for the section.
4. Explain the types of anaesthesia to her and ascertain
which she would prefer.
5. Inform the anaesthetist of her choice.
6. Give her a guide as to what the procedure will entail
Indications cont.
7. Obtain blood for grouping and haemoglobin levels.
8. Commence an intravenous infusion if she does not
already have one insitue. Give prophylactic antibiotics.
9. Inform the theatre team.
10. Inform the paediatrician
11. Shave the woman’s abdominal and pubic hair, if you
consider that it will be over the incision line.
12. Catheterise the patient.
13. Cover the woman’s rings with adhesive tape, and
ensure that the relatives keep any valuables.
14. If no relatives are present the woman’s valuables should
be signed for of the notes, and the valuables locked away.
15. Ensure that the woman has an identification band with
her name, hospital number, and date of birth on it.
16. If the woman has dentures, these should be removed.
17. If the woman has an artificial limb or artificial eye these
should be removed.
18. Give an antacid, usually Magnesium Trisilicate 30ml to
reduce the risk of acid aspiration syndrome.
19. Find out if the woman is allergic to any drugs, or to
elastoplast.
20. Give antibiotics if this is the hospital policy.
21. Prepare baby notes, and prepare to resuscitate the
baby - oxygen, laryngoscope, ambu bag, incubator.
22. Complete an anaesthetic form, recording blood
pressure, pulse and temperature.
23. Ascertain how she wants to feed the baby.

 Uterine infection Wound infection
 Dehiscence of surgical wound Haemorrhage
 Deep vein thrombosis Pulmonary embolism
 Urinary tract infection Urinary
complications
 Chest infection Bowel injury
 Paralytic ileus Anaesthetic
complications
 Electrolyte imbalance Psychological
 Uterine Infection

Complications Increased for:
Those under 18 years Obese women
Prolonged rupture of membranes Prolonged
labour
Repeated vaginal examinations Presence of
chorioamnionitis
Inexperienced surgeon And where
prophylactic antibiotics were not used.

Wound Infection
Infection is 10 - 20 % higher for C/S patients than for
normal delivery.
Organisms: B Streptococcus, E. Coli, Anaerobes

Predisposing factors:
Prolonged labour Prolonged rupture of
membranes
Inexperienced surgeon High number of
vaginal examinations
Obesity
Prophylactic management: Antibiotics before surgery
Wound Dehiscence
This is when the wound bursts open, usually after the
sutures are removed.
Contributing factors
Poor nutritional Status
Infection
Carcinoma
Management
Deep retention sutures
Improve Nutrition
Haemorrhage
Bleeding may be from the placental bed, or from a tear into
major blood vessels.
Risk factors:
Placenta praevia, Placental abruptio
Atonic uterus due to multiple pregnancy
Management
Ringers Lactate
Syntocinon I.V. bolus (10 i.u. of oxytocin) then, 40 i.u.
in 1,000mls of normal saline.
If bleeding continues then the woman may require to
be return to theatre to have the bleeding vessel ligated.
Deep Vein Thrombosis and Pulmonary Embolism
Prevention
Early ambulation
At administration of anticoagulants to women at risk
of DVT is debatable.
Dextran given I.V during surgery for those at risk.

Urinary Tract Infection
Associated cause:
Catheterisation before surgery (indwelling catheters result
in a greater risk).
In/out catheters reduce infection although the procedure
may have to be repeated several times, as 20% of women
following C/Shave difficulties voiding and 11% have post
micturition residual urine.
This could be reduced with adhering to strict sterile
technique.

Urinary Complications
There is a risk of bladder damage during a caesarean
section.
The Ureters could be damaged.
Necrosis of the bladder due to obstructed labour.
Vesico-vaginal fistular, following obstructed labour.
If damaged it should be repaired during the operation

Indwelling catheter to be on continuous drainage for 7 - 10
days.
Chest Infection
Occurs in up to 10% of patients following abdominal surgery.
Predisposing factors
Obesity, Smoking
Pre-existing upper respiratory tract infection General
anaesthesia

Prevention
Early ambulation Post-operative analgesia
Prophylactic physiotherapy

Bowel Injury Damage due to adhesions
Paralytic Ileus This is spasm of the bowel.

Pass nasogastric tube and give I.V. fluids
Anaesthetic Complications

Causes
Failure to perform endotracheal intubation
Inhalation of acidic stomach contents (MendelsonÕs
syndrome)
Prevention
This can be reduced with cricoid pressure during
intubation and antacids prior to delivery

Electrolyte Imbalance
In women following caesarean section the normal
diuresis is delayed or diminished by the alterations in
kidney function associated with metabolic response
(Lawson Stewart 1967). It is therefore important not
to overload the woman following surgery
Psychological
Women are less likely to breast feed and are less
confident with themselves.
More prone to depression
Due to lack of contact at delivery there is a feeling of
maternal incompetence and lack of confidence.
Women who have an emergency C/S feel that they
have failed or have done something wrong (Marut
Mercer 1979).
Women have fewer positive feeling about their birth
(Kirchmeier 1984).
Regional anaesthesia results in a more positive
attitude.
The presence of the partner in the theatre also
increases positive feelings.
Fathers often feel left out of it.

The baby
Care Immediately following delivery
Call the paediatrician when the surgeon is ready to
commence the operation, if not already present.
Scrub up and take the baby from the surgeon
Hold the baby with his head slightly tilted downwards
Put the baby on the resuscitation trolley
Note the sex of the baby and inform the mother of the
sex and the condition of the baby if she is awake.
The baby will need his air ways clean due to the extra
fluids in the lungs.
Give Vitamin K 1mg should be given.
If the mother is awake then show the baby to the
mother as soon as possible.
It is usually possible for her to stoke the baby
Depending on the condition of the mother and the
willingness of the anaesthetist it may be possible to
allow her to hold the baby and breast feed the baby.
The father if present could be given the baby to hold.
The labels for the baby should be checked by the
mother or another member of staff in the room.
Weigh and dress the baby and return it to the father.
Once the operation is over and the woman is out of
theatre, assist her with the first breast feed.
Subsequent Attention
The mother will need help to change the babies

nappies.
The mother may require help with feeding the baby
and bathing the baby.
The mother should be discharged on family planning.
The woman must know why she had the caesarean
section.

Complications for the baby
Respiratory Distress Syndrome, especially if it was an elective

caesarean section.
Sleepy baby if the mother had a general anaesthetic.
Asphyxia neonatorum due to:
distress before the operation - meconium aspiration
excessive secretions
This results in - hypothermia, hypoglycaemia
Injury - could be cut with the surgeons knife if the uterus is very
thin.
Management after delivery
 Collect the patient form the theatre and obtain information about:-
 anaesthetic, condition in theatre, IV fluids given and to be given,
blood loss
 Ensure that the charts are all filled in.
 Do 1/4 hourly observations of blood pressure and pulse until stable.
 Temperature 4 hourly
 Analgesia as ordered
 The baby should go to the breast as soon as the mother returns from
theatre.
 Remove the catheter after 6 hours unless, the urine is not clear,
oliguria is present, or they had a spinal anaesthesia
Cont.
If spinal anaesthesia to remain flat for 24 hours, to
prevent spinal headache.
If general anaesthesia then sit the patient up as soon
as she is conscious to prevent pneumonia.
Encourage leg exercises if in bed.
Remove the dressing after 24 hours and redress
Remove the dressing on the 5th day.
Remove sutures on the 8th and 9th day if
nonabsorbent.
Home on the 10th day
conclusion
In your groups describe the pre operative care of a
woman going for elective C/S.(20 marks)
Describe the post operative care of a woman who have
under go (c/s)(20 marks)
Describe the pre-operative care of a woman going for
emergency c/s (20 marks)
Describe four major complications associated with c/s
(20marks)
Evaluation
Group presentations and evaluating.
THE
END
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CAESERIAN SECTION

PRESENTER SENIOR MIDWIFE MITI

GROUP September 2016

HOURS Two hours

If damaged it should be repaired during the operation

Paralytic Ileus This is spasm of the bowel.

The mother will need help to change the babies

Respiratory Distress Syndrome, especially if it was an elective

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