Caesarean section is the delivery of a fetus through an incision made in the mother's abdomen and uterus. It was originally a fatal operation but is now commonly performed worldwide. The WHO recommends an ideal c-section rate of 15-20% though rates have increased due to factors like previous c-sections and increased fetal distress diagnosis. C-sections are performed under spinal or epidural anesthesia with various abdominal incision types closed afterwards. Complications can include hemorrhage, infection, and injury to internal organs during the operation or issues like ileus, DVT and wound separation after.

1. CAESAREAN SECTION
“YET ANOTHER WAY TO GET OUT!”

2. WHY CALLED SO??
 According to legend ,julius caesar was born
by this operation
 It was a fatal operation until beginning of 20th
century.
 Now the most common operation performed
worldwide

3. DEFINITION
 The delivery of a viable fetus through an incision in
the abdominal wall and uterus.
 Definition does not include removal of fetus from
abdominal cavity in case of rupture uterus.
 WHO recommends an ideal caesarean rate of 15-
20%.
 But in most countries it is 15-20%

4. WHY RATES INCREASED?
 Increase in repeat caesareans.
 Difficult instrumental delivery and vaginal
breech deliveries
 Increased diagnosis of intrapartum fetal
distress
 Caesarian on demand
 Identification of risk of mothers and fetuses
 Increase in pregnancies by invitro fertilization

5. INDICATIONS
 Previous caesarian section
 Dystocia or dysfunctional labour
 Fetal distress
 Breech presentation
 Antepartum haemorrhage
 Maternal problems
 Caesarian section on demand

6. LSCS

7. • Cross matched blood
• Catheter introduced
• Antibiotic prophylaxis
• Heparin as thromboprophylaxis
• Parts cleansed with antiseptic solution
• Left lateral position- reduce aortocaval
compression.
reduce risk of supine
hypotension

8. ANAESTHESIA
• GA or REGIONAL
• REGIONAL - Spinal or Epidural
• Mendelson’s syndrome- GA given as
emergency- risk of aspiration- chemical
pneumonitis.
• To counteract- antacids given during
labour, oral fluids withheld
• 30 ml 0.3 molar sodium citrate orally -1/2 hr
before surgery.
• Sellick’s manoeuvre- endotracheal
intubation accompained by pressure on

9. ABDOMINAL INCISIONS
Pfannensteil incision-MC
used.
Transverse curvilinear incision
above pubic hairline
Deepened through s/c tissue upto
rectus sheath
Rectus sheath divided
transversely

10. Maylard incision
Option when more exposure is
needed in transverse incision
Recti muscles are divided
Midline vertical incision

11. Transverse Vertical incision
incision
Cosmetic appeal More Less
Postoperative pain Less More
Wound dehiscence Less More
Incisional hernia Less More
Technical skill More Less
Time taken More Less
Access to upper Less Good, can be
abdomen extended

12. PROCEDURE
• Once abdomen opened- dextrorotation of
uterus corrected
• Doyen retractor- visualize lower segment
• Peritoneum over lower segment identified-
divided transversely- seperated from bladder
by blunt dissection
• Small incision in lower segment-extended
laterally
• Inadequate space- J shaped or inverted T
incision
• Do not injure uterine vessels lying laterally

13. DELIVERY OF BABY
Cephalic presentation
Hand slipped into uterine cavity
Head is levered out gently
Floating head- use forceps to deliver the
baby.
Breech presentation
feet hooked out first
rest delivered as vaginal breech
delivery

14. Transverse or oblique lie
corrected to longitudinal lie before
making uterine incision.
Transverse lie with ruptured
membranes & undeveloped lower
segment
extension of uterine incision
required

15. CLOSURE OF UTERINE INCISION
 OXYTOCIN infusion started as soon as
baby is delivered
 Uterine fundus contracts-placenta and
membranes extrudes spontaneously-
removed
 Wipe with moist pad- ensure uterine cavity
is empty and cervical canal is open
 Uterine edges- held with ALLIS forceps or
GREEN ARMYTAGE forceps- incision
closed in 2 layers- continuous sutures

16. Chromic catgut or polyglactin used
Any bleeding points- controlled with figure-
of-eight sutures

17. CLOSURE OF ABDOMEN
• PERITONEUM- closed or not closed
• RECTUS SHEATH-non absorbable sutures-
proline- to reduce wound dehiscence &
incisional hernia
• SUBCUTANEOUS TISSUE-closed
• SKIN- mattress sutures of silk, subcuticcular
suture or clips

18. POST OPERATIVE CARE

19.  Close monitoring for 1st 6-8 hrs
 Parenteral fluids
 Blood transfusion if needed
 Analgesics and sedatives
 Oral fluids
 Early ambulation and deep breathing
exercises
 Light solid diet n laxatives
 Discharged –day following suture
removal/if transverse or subcuticular-5th/6th
day

20. ADVANTAGES OF LSCS
 Healing better
 Scar rupture minimal

21. OTHER TYPES OF CS
 1. Low segment vertical incision
 2.Classical CS
 3.Extra peritoneal CS
 4.Caesarean hysterectomy

22. LOWER SEGMENT VERTICAL INCISION
 Indications:Constriction ring,lower segment
not formed
 Disadv:
injury to cervix, vagina,bladder
increased chance of rupture in next
pregnancy

23. CLASSICAL CAESAREAN
Indications
lower segment unapproachable
CA cervix
Anterior placenta praevia with prev caesarian
Transverse lie with ruptured membranes
Conjoint twins
Disadvantages
Difficult healing
Scar rupture
General peritonitis

24. EXTRAPERITONIAL CAESAREAN
 Severe infection
 Extraperitoneal approach
 Space of Retzius

25. CAESAREAN HYSTERECTOMY
Indications
Severe atonic PPH
Placenta accreta,increta,percreta
Sepsis
Multiple large myomas
CA cervix

26. COMPLICATIONS OF CAESAREAN SECTION

27. INTRAOPERATIVE COMPLICATIONS
 Primary haemorrhage
 Injury to internal organs
 Injury to the baby
 Difficulty in delivery of the head
 Anaesthetic complications

28. PRIMARY HAEMORRHAGE
 Atonic-
oxytocin 20units in 500ml
ergometrine0.25mg im or iv
prostaglandin F2 alpha 250micgram im and
intramurally
PGE1 200micgram rectally
 Traumatic-ligation of concerned vessels
 Placenta accreta

29. POSTOPERATIVE COMPLICATIONS
 Paralytic ileus
 Respiratory complications
 Infections
 Peritonitis
 Pelvic abscess
 Pelvic thrombophlebitis
 Deep vein thrombosis and pulmonary
embolism
 Wound dehiscence

30. LATE SEQUELAE
 Secondary PPH
 Incisional hernia
 Scar endometriosis
 Vesico-vaginal fistula
 Scar rupture in the next pregnancy
 Placenta praevia and placenta accreta
 Bladder injury