CAESAREAN SECTION

Word caesarean is derived from the Latin

word ‘CADERE’ which means ‘to cut’.
 It is an operative procedure whereby the
fetuses after the end of 28th week are
delivered through an incision on the
abdominal and uterine walls.
 NEED OF CAESAREAN SECTION
Due to increase awareness of fetal
wellbeing
Identification of at risk mothers.
Wider use of caesarean section in post
caesarean pregnancies and
malpresentation.
Increased prevalence of primigravid
mothers in hospital population.
Improved anesthesia ,
availability of blood
transfusion and antibiotics.
ABSOLUTE RELATIVE
INDICATIONS INDICATIONS
Central placenta Cephalo-pelvic
praevia disproportion
Contracted pelvis Previous uterine scar
Cervical fibroid Fetal distress during
first stage
Advanced carcinoma Ante partum
cervix hemorrhage
Vaginal atresia Hypertensive
disorder
TIME OF OPERATION
ELECTIVE:- When the operation is done at
a prearranged time during pregnancy to
ensure best surgical conditions
EMERGENCY:-When the operation is done
due to unforeseen complication arising
either during pregnancy or during labour
without wasting time.
DEFINITION
LSCS is the operation in which the
extraction of the baby is done through an
incision made in the lower segment
through a transperitoneal approach.
PREOPERATIVE PREPARATION
Abdomen is prepared as for laprotomy.
Ranitidine (H2blocker) 150 mg is given
orally night before (elective procedure)
and it is repeated (50mg I.M or I.V.) one
hour before the surgery to raise the
gastric Ph.
…Contd
Metoclopromide (10mgI.V.)is given to
increase the tone of the lower esophageal
sphincter as well as to reduce the
stomach contents. It is administered after
about 3 minutes of pre-oxygenation in the
theatre.
The stomach should be emptied , if
necessary by a stomach tube (emergency
procedure).
…contd
Bladder should be emptied by a soft rubber
catheter which is kept in place till the end of
the operation.
FHS should be checked at this stage
POSITION OF THE PATIENT
The patient is placed in the dorsal position .
In susceptible cases , to minimize any
adverse effect of venacaval compression , a
15degree tilt to her left using sand bags till
delivery of the baby is beneficial.
ANTISEPTIC PAINTING
The abdomen is painted with 7.5%
Povidone iodine solution or savlon lotion
followed by spirit and to be properly
draped with sterile towels.
INCISION ON THE ABDOMEN
A vertical infraumblical midline or Para
median incision is usually employed ,
the incision extends from about 2.5 cm
below the umbilicus to the upper
border of the symphysis pubis .
Alternatively , a low transverse incision
is made about two fingers breadth
above the symphysis pubis.
TRANSVERSE INCISION
ADVANTAGES DISADVANTAGES

1.Post operative 1.Takes longer time

comfort is more and unsuitable in
acute emergency
operation
2.Fundus can easily Blood loss is little
be palpated more
immediate post
operative period
……Contd
ADVANTAGE DISADVANTAGE

3.Less chance of 3.Requires

wound dehiscence competency during
and incisional repeat section
hernia

4.Cosmetic value 4. Unsuitable for

classical operation
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.
UTERINE INCISION
PERITONEAL INCISION:-The loose
peritoneum is cut transversely across the
lower segment with convexity downwards
at about 1.25 cm (1/2”)below its firm
attachment to the uterus .
………Contd
MUSCLE INCISION:-A small transverse
incision is made in the midline by a
scalpel at a level slightly below the
peritoneal incision until the membranes
of the gestation sac are exposed .
Two index fingers are then inserted
through the small incision down to the
membranes and the muscles of the lower
segment are split transversely across the
fibers.
……Contd
The method minimizes the blood loss but
requires experience.
Alternatively , the incision may be
extended on either sides using a pair of a
curved scissors to make it a curved one of
about 10cm (4”) in length , the concavity
directed upwards.
DELIVERY OF THE HEAD
The membranes are ruptured if still intact.
The blood mixed amniotic fluid is sucked
out by the sucker.
The Doyen’s retractor is removed.
The head is delivered by
hooking the head
with the fingers.
….Contd
As the head is drawn to the incision line ,
the assistant is to apply pressure on the
fundus.
If the head is jammed , an assistant may
push up the head by sterile gloved fingers
introduced into the vagina.
The head can also be delivered using
Wrigley’s forceps.
DELIVERY OF THE TRUNK
As soon as the head is delivered , the
mucus from the mouth pharynx and
nostril is to be sucked out using rubber
catheter .
After the delivery of the shoulder ,
intravenous methergin 0.2mg is to be
administered.
The rest of the body is delivered slowly
The cord is cut in between two clamps
The Doyen’s retractor is reintroduced
REMOVAL OF THE PLACENTA AND
MEMBRANES
The placenta is extracted by traction on
the cord with simultaneous pushing the
uterus towards the umbilicus per abdomen
using the left hand (CCT)
Routine manual removal
should not be done
SUTURE OF UTERINE WOUND
 The suture of the uterine wound is done with
the uterus keeping in the abdomen
 The margins of the wound are picked by the
Allis tissue forceps or Green Armytage
haemostatic
clamps
….Contd
FIRST LAYER:- the first stitch is placed
on the far side in the lateral angle of
the uterine incision and is tied .
The suture material is No. ’O’ chromic
catgut and the needle is round bodied
 A continuous running suture taking
deeper muscles excluding the decidua.
…..Contd
SECOND LAYER:- A similar continuous
suture is placed taking the superficial
muscles and adjacent fascia
overlapping the first layer of the suture
THIRD LAYER (peritoneal):-The
peritoneal flaps are apposed by
continuous inverting sutures (to
prevent any raw surface)
AFTER CARE
IN FIRST 24 HOURS:-
Observe the patient for 6-8 hours.
Give fluids 5% dextrose or ringer
lactate.
In anemic mothers blood transfusion is
important.
Injection methergin 0.2mg can be
repeated.
Prophylactic antibiotics
can be used in first 24 hours.
SECOND DAY
Start the oral feed.
Baby is put to breast.
Light solid diet of
patient choice is given.
Bowel is kept emptied
 SIXTH-SEVENTH DAY
Abdominal skin stitches are to be removed on
the sixth day.
COMPLICATIONS OF LSCS
IMMEDIATE COMPLICATIONS:-
Post partum hemorrhage
Shock
Sepsis
Anesthetic hazards
Intestinal obstructions
Thrombosis
Wound complications
Secondary PPH
REMOTE COMPLICATIONS
Gynecological :-Menstrual excess or
irregularities, chronic pelvic pain or backache
Surgical complications:-Incision hernia,
intestinal obstructions.
Future pregnancy:-Scar rupture
FILL IN THE BLANKS
Caesarean word has been derived from
the latin word which means
‘to cut’
Two absolute indications for caesarean
are
ante partum hemorrhage and
contracted pelvis .
Ranitidine
is given night before the elective operation.
Yes or No
Wrigley’s retractor is introduced during
procedure.
The suture material is No. 0 chromic
catgut during suturing.
Give enough of sedatives to the patient
preoperatively.
Routine manual removal of placenta must
not be done.