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Cesarean Section: A Brief Discussion Of The Procedure

Giving birth to an infant is a risky job if the mother has some serious complications. In those situations, doctors perform Cesarean Section. It is an operative procedure which reduces the complications of delivery to a great extent.

Definition:

It is an operative procedure whereby the fetuses after the end of the 28th week are delivered through an incision on the abdominal and uterine wall.

Indications:

Absolute: Vaginal delivery is not possible. Cesarean section is needed even with a dead fetus.

  1. Grossly contracted pelvis.
  2. Central placenta praevia.
  3. 2 or more cesarean section.
  4. Pregnancy following successful repair of V.V.F.
  5. Transverse lie at term.

Relative: vaginal delivery may be possible but the risk to the mother and/or baby are high.

  1. C.P.D.
  2. Previous cesarean delivery.
  3. Non reassuring F.H.R.(fetal distress.)
  4. A.P.H.
  5. Malpresentation.
  6. B.O.H.
  7. Failed induction.
  8. Hypertensive disorder.
  9. Medical Disorder.

 

Time of operation:

Elective.
Emergency.

Type of operation:

Lower segment.
Classical or upper segment.

Preoperative preparation:

  1. Informed written consent for the procedure, anesthesia, and B.T.
  2. The abdomen is scrubbed with soap, hair may be clipped.
  3. Antacid, H2 blocker to raise the gastric pH.
  4. The bladder should be empty-by a soft rubber catheter.
  5. The stomach should be empty (N.P.O. 6 hours before the operation).
  6. F.H.S. should be checked.
  7. Neonatologist should be available.

Anesthesia:

S.A.B. (subarachnoid block), epidural or GA may be given.

The position of the patient:

Dorsal. 15◦ tilt to left.

Antiseptic painting:

The incision on the abdomen: 

Vertical.
Transverse/Pfannenstiel.

Cesarean section incesions

Uterine incision: 

Low transverse.
Classical.

Postoperative care:

  1. Monitoring of vital sign-pulse, BP, respiration, temperature, dehydration, the behavior of the uterus, P/V bleeding, urinary output.
  2. I/V fluid.
  3. Prophylactic antibiotics.
  4. Analgesics.
  5. Ambulation.
  6. Baby is put to the breast.

Complications:

Maternal:

Intra-operative:

  1. Anesthetic hazards- Mendelson’s syndrome, cardiac arrest, Hypotension.
  2. Extension of uterine incision.
  3. Injury to the UB, ureter, and rectum.
  4. P.P.H. – atony, morbid placental adhesion.

Postoperative:

  1. P.P.H.
  2. Shock.
  3. Infection
  4. Aspiration pneumonia.
  5. Intestinal obstruction.
  6. Thromboembolism
  7. Wound complication-hematoma, dehiscence, burst abdomen.
  8. Secondary P.P.H.

Remote complication:

Incisional hernia, intestinal obstruction.Scar rupture.

Fetal complication:

Iatrogenic prematurity, R.D.S.

Thus, Cesarean Section is a widely used procedure on the eve of one’s birth!

The Author

Dr. Sujon Paul

The author of this post is Dr. Sujon Paul, an MBBS Doctor. He is also a blogger and updates this website [HITBANGLA.COM] regularly with fresh contents. Thank you for visiting this website. Contact Author: Facebook, Twitter & Google Plus

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