CAESAREAN SECTION

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INTRODUCTION
An operative procedure that is carried out
under anesthesia whereby the fetus,
placenta and membranes are delivered
through an incision in abdominal wall
amd the uterus
Usually carried out after viability has
been reached i.e. 24-48 weeks of gestation
onwards.
The first operation performed on a
women is referred to as a primary
caesarean section.

When operation is performed in

subsequent pregnancies,it is called repeat
caesarean section.(C/S)
INCIDENCE:
The incidence of caesarean is steadly raising.
During the last decade there has been two-three
folds rise in the inciddence from the initial rate
of about 10%.
Factors responsible are increased safety of
operation due to improved anesthesia,
availability of blood transfusion and antibiotics.
Increased awareness of fetal well being and
idenification of risk factors have caused
reduction of difficult operation or manipulative
vaginal deliveries.
Indication for Caesarean section

1. Absolute:
 Vaginal Atresia
 Advanced carcinoma of cervix
 Cervical or broad of contracted pelvis.
 Severe degree of contracted pelvis.

2. Relatives:
 Cephalopelvic disproporton
 Previous uterine scar
 Fetal distress.
 Malpresentations
 Antepartum hemorrhage
 Elderly primigravidae
 Chronic hypertension
 Diabetes

3.Fetal indicaton:
Fetal distress
Umbilical cord prolapse
Macrosomia
Placental insufficiency
Multiple pregnancy
Contraindication:
Dead fetus
Baby is too much premature
Presence of blood coagulation disorder
Time of operation:
A. Elective caesarean section:
The term elective indicates that the
decision to deliver the baby by caesarean
has beenmade during the pregnancy anh
before the onset of labour.
It means pre-planning for doing caesarean
section.
Indication:
CPD
Placenta previa
B. Emergency caesarean delivery:
When the operation is performed due to
unforseen complication arising either
during pregnancy or labour without
wasting time following the decision.
Indication:
Cord prolapse
Uterine rupture
Eclampsia
Prolonged first stage of labour
Abnormal uterine contraction
Placenta previa diagnosed in labour.
Types of operation:
1. Lower segment caesarean section:
Is lesser muscular than the upper segment of
the uterus.
Transverse incision is made in the lower
segment this heals faster and sucessfully than
an incision in the upper segment of the uterus.
There is less muscle and more fibrous tissue
in lower segment which reduces the risk of
rupture in a subsequent pregnancy.
Also known as “pfannensiel or bikini line
incision.”
2. Classical caesarean section:
In this baby is extracted through
an
incision made in upper segment of uterus.
Is rarely performed.
Operation is done only under forced
circumstances, such as:
carcinoma of cervix
Big fibroid on lower segment
constriction ring
lower segment is difficult or risky example:placenta
previa, adhesion due to previous abdominal
operation.
Supplies/ Equipment
1. Extra drape sheet
2. Towels
3. Receiving pack for baby
4. C-section tray
5. Delivery forceps
6. Cord clamp
7. Basin set
8. Blades
9. Neonatal receiving unit
10. Self-contained oxygen
11. I.D bands
12. Suction
13. Bulb syringe
14. Solutions
 Operation procedure:
 The non gravid uterus is a pelvic organ closely covered by a
layer of pelvic peritoneum.
 As pregnancy advances, the uterus grows up into the abdomen
and this peritoneum rises up with the uterus and comes into
contact with the abdominal peritoneum. Each of these layers
must be incision and repaired.
 The abdominal peritoneum is situated below the abdominal
muscles layer.
 The anatominal layers are:
a) Skin
b) Fat
c) Rectus sheath
d) Rectus abdominis
e) Abdominal peritoneum
f) pelvic peritoneum
The operation most commonly carried out is the
lower segment caesarean section.
The lower segment incision is in the less
muscular and active part of the uterus and heals
better.
The main reason for preferring the lower uterine
segment technique is the reduced incidence of
dehiscent pregnancy.
The abdomen is opened and the loose folds of
the peritoneum over the anterior aspect of the
lower uterine segment and above the bladder is
incised. The operator continues so incise this
further to visualize the fundus of bladder which
is then pushed down and away from the surgeon.
The surgeon direct the fetal head out while the
assistant applies fundal pressure to hip the
delivery of the baby.
Oxytocins may be given by the anesthetist after
delivery of the baby and clamping the cord.
When the baby and placental have been delivered
the uterus is sutured.
This is usualy done in two layers. The peritoneum
then be clased over uterine wound to exclude it
from the peritoneal cavity.
The rectus sheath is closed then the layers of fat
and finally the skin is sutured with the surgeons
choice of materials; commonly vicryl a braided
polyglactin preparation is used for this.
Nursing Management
A. Pre-operative management:
 Patient should be physically prepared
i.e.abdomen,back ,private parts and upper part os
thigh are shaved and cleaned.
 Prepare mother psychologically by providing
assurance a nd explanning the indication,procedure
and need of caesarean section.
 Administration of IV infusion of 50% dextrose to
avoid hypotension following spinal anaesthesia,the
infusion line is maintained patent by an intra venous
cannula.
 Blood grouped and cross matched for emergency
requirement.
Bladder should be empty by inserting foleys
catheter.This may be done before and after
induction of anaesthesia.
Mother should be in NPO for about 8 hours.
Patient should be in clean gown,valuable
ornament should be taken off and all make
up should be removed.
If elective caesarean section then Ranitidine
150mg should be given orally in the night
before and repeated one hour before surgery
to prevent gastric PH
B. Post operative care :
1. Immediate care (4-6 hours):
• In the immediate recovery period,the blood
pressure is recorded in every 2 hourly.
• The wound must be inspected half hourly to
detect any blood loss.
• The lochia are inspected and drainage should be
small initially,Following general anaesthesia,
the women is nursed in left lateral or recovery
position until she is fully conscious.
• Analgesic is given as prescribed.
2. First 24 hours:
 IV fluids are continued,blood transfusion is helpful in
anemia mothers.
 Parental antibiotic is usually given for 1st 48 hours,analgesics
is the form of pethidine 75-100mg are given as needed.
 Ambulation is encouraged following day of surgery and baby
is given to mother.

3. After 24 hours:
 TPR are usually checked every 4 hourly
 Orally feeding is started with clear liquid and then advanced
to normal diet and IV fluid are continued for about 48 hours.
 Catheter may be removed on following day when the women
is able to get up to the toilet. She should be helped to get out
of bed.
 The mother must be encouraged to take rest and provide care
to the baby and should breast feed the baby.
Complication:
Mother:
partum hemorrhage related to uterine atony and
rarely blood coagulation disorders.
Shocks related to blood loss.
Anesthesia hazards
Sepsis, secondary PPH.
Thrombosis
Lung infection post.
Late compilcation:
Menstrual irregularity
Chronic pelvic pain
Backache

Fetus:
Iatrogenic prematurity.
Respiratory distress syndrome.
Injury to baby due to surgical knife.
Birth asphyxia due to anaesthesia.