Cesarean section
Definition
• It is an operative procedure whereby the fetuses after the end of 28th weeks
are delivered
• through an incision on the abdominal and uterine walls.
• The first operation performed on a patient is referred to as a primary cesarean
• section. When the operation is performed in subsequent pregnancies, it is called
repeat cesarean section.
Indications
• ABSOLUTE INDICATIONS
• Vaginal delivery is not possible. Cesarean is needed even with a dead foetus
• Central placenta previa
• Contracted pelvis or cephalopelvic disproportion (absolute)
• Pelvic mass causing obstruction (cervical or broad ligament fibroid)
• Advanced carcinoma cervix
• Vaginal obstruction (atresia, stenosis)
RELATIVE INDICATIONS
Vaginal delivery may be possible but risks to the mother and/or baby are high
• Cephalopelvic disproportion (relative)
• Previous cesarean delivery—
• when primary CS was due to recurrent indication (contracted pelvis)
• Previous two CS
• Features of scar dehiscence
• Previous classical CS
• Non-reassuring FHR (foetal distress)
• Dystocia may be due to (three Ps)
• relatively large foetus (passenger)
• small pelvis (passage)
• inefficient uterine contractions (power)
• Antepartum haemorrhage:
• Placenta previa
• Abruptio placenta
• Malpresentation:
• Breech
• shoulder (transverse lie)
• brow
• Failed surgical induction of labor, failure to progress in labor
• Bad obstetric history—with recurrent fetal loss
• Hypertensive disorders:
• Severe preeclampsia
• Eclampsia—uncontrolled fits even with antiseizure
• Medical-gynaecological disorders:
• Diabetes (uncontrolled),
• Heart disease (coarctation of aorta, Marfan’s syndrome)
• Mechanical obstruction (due to benign or malignant pelvic tumours
(carcinoma cervix), or following repair of vesicovaginal fistula
Common indications
Primigravida Multigravida
• Failed indication • Previous cesarean delivery
• Foetal distress (non-reassuring fetal • Antepartum hemorrhage (placenta previa,
FHR) placental abruption)
• Cephalopelvic disproportion (CPD) • Malpresentation (breech, transverse lie)
• Dystocia (dysfunctional labor, non-
progression of labor
• Malposition and malpresentation
(occipito-posterior, breech)
Types of C-section
TYPES OF OPERATIONS:
• Lower segment
• Classical or upper segment
Classical
• Classical: In this operation, the baby is extracted through an incision made in the upper
segment
• of the uterus. Its indications in present day obstetrics are very much limited and the operation is
only
• done under forced circumstances such as:
• Lower segment approach is difficult: (1) Dense adhesions due to previous abdominal
operation
• (2) severe contracted pelvis (osteomalacic or rachitic) with pendulous abdomen.
• Lower segment approach is risky: (1) Big fibroid on the lower segment—blood loss is more
• and contemplating myomectomy may end in hysterectomy (2) carcinoma cervix—to prevent
• dissemination of the growth and postoperative sepsis (3) repair of high VVF (4) complete anterior
• placenta previa with engorged vessels in the lower segment—risk of hemorrhage.
• Perimortem cesarean section: It is done to have a live baby (rare). Perimortem section is an
• extreme emergency procedure. Classical section is done in a woman who has suffered a cardiac
• arrest. The infant may survive if delivery is done within 10 minutes of maternal death.
Lower segment
• Lower segment cesarean section (LSCS): In this operation, the extraction of
the baby is done
• through an incision made in the lower segment through a transperitoneal
approach. It is the only
• method practiced in present day obstetrics and unless specified, cesarean section
means lower segment
• operation. The operation done through an extraperitoneal approach to the lower
segment in infected
• cases is obsolete.
