Caesarean Section Medical Presentation

Caesarean Sections PowerPoint Presentation

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Published on : Apr 06, 2018 | Views : 2043 | Downloads : 0

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Presentation Outline Definition History Epidemiology Types Indications Risks/ complications Pre-Op Operation Anatomy of Anterior Abdominal Wall Post Op TOLAC VBAC
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Definition A caesarean section is a surgical procedure in which incisions are made through a woman’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies.
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History Three theories about the origin of the name caesarean; Roman legal code called Lex Caesarea-law stated that the baby should be cut out of the mother’s womb in the case that she dies before giving birth. 1st century AD story by Pliny the Elder, who claimed that an ancestor of Caesar was delivered in this way
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Derived from the Latin verb caedere, to cut The first recorded survivor 1500 in Switzerland: Jakob Nufer, a pig gelder, performed on his wife after a prolonged labour. March 5th, 2000, Inés Ramírez performed a caesarean section on herself and survived, as did her son.
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Epidemiology UK 25% and 30% of deliveries U.S. rate in 2011 was approximately 33% Maternal mortality (<0.1%) Case fatality rate for all caesarean sections is five times that for vaginal delivery
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Classification Elective usually booked days or weeks ahead of time and are conducted during daytime hours Emergency All other caesarean sections, irrespective of whether the woman was in labour or not.
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Abdominal Incisions Pfannenstiel/ Transverse curvilinear incision 2 fingerbreadths above the symphysis pubis extending from and to points lateral to the lateral margins of the abdominal rectus muscle
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2. A transverse suprapubic incision with no curve advantages of improved cosmetic results, decreased analgesic requirements and superior wound strength.
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3. A vertical skin incision lower midline incision made from the lower border of the umbilicus to the symphysis pubis, and may be extended caudally toward the xiphisternum.
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Indications : extreme maternal obesity surgical intervention for other intra-abdominal pathologies where access to the uterine fundus may be required (classical caesarean section).
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Advantages greater ease of access to the pelvic and intra-abdominal organs May be enlarged more easily Disadvantage higher incidence of wound dehiscence
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Uterine Incisions Low Transverse Uterine Incision Most commonly used Location: the non-contractile portion of the uterus The bladder must be dissected off the lower uterine segment. Risk of uterine rupture in subsequent labor : 0.5%.
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Classical/ Sanger Less commonly performed Location: made in the contractile fundus of the uterus Repeat cesarean should be scheduled before labor onset.
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Indications Emergency lower uterine segment fibroids lower segment covered with dense adhesions placenta previa, abruption transverse lie with the back down fetal abnormality (e.g. conjoined twins) carcinoma of the cervix Postmortem CS Cord prolapse
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Low vertical The vertical incision begins in the non-contractile lower segment but usually extends into the contractile upper segment
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Uterine rupture in future pregnancies (1) Low transverse scar (one): less than 1% (2) Low vertical scar: 0.5% to 6.5% (3) Classic scar: as high as 10%
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Indications The four major indications accounting for greater than 70% of operations are: Previous caesarean section. Malpresentation (mainly breech). Failure to progress in labour (CPD). Suspected fetal compromise in labour. Other indications, such as multiple pregnancy, placental abruption, placenta praevia, fetal disease and maternal disease, are less common.
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Risks Hemorrhage: Mean blood loss of 1,000 mL Causes Uterine atony Placenta previa Damage to uterine vessels
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Management oxytocin infusion, prostaglandins, bimanual compression, uterine compression sutures, hysterectomy. Indications for hysterectomy; uterine atony, rupture, extension of a transverse uterine incision and obstructive.
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• Infection: Sites of infection include endometrium, abdominal wall wound, pelvis, urinary tract, or lungs. Prophylactic antibiotics can decrease infectious morbidity.
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• Visceral injury: Surrounding structures can be injured (e.g., bowel, bladder, and ureters). • Thrombosis: Deep venous thrombosis is increased in the pelvic and lower extremity veins.
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References Sakala,P. (2016). USMLE STEP 2 CK Lecture notes 2017 Obstetrics and Gynecology. New York: Kaplan Inc. Kenny,L. (2017) .Obstetrics 20th Edition by Ten Teachers. Manchester, UK :CRC Press Taylor & Francis Group.