Caesarean Section

Caesarean Section
Caesarean Section is an operative procedure whereby the foetuses after the end of 28th week are delivered through an incision on the abdominal and uterine walls. About 10% of all deliveies these days are conducted through caesarian section.

Types of operations: There are two types of caesarean sections

• Lower segment (L.S.C.S)
• Classical or upper segment

Lower Segment Caesarean Section - Here the extraction of the baby is done through an incision made in the lower segment of uterus. It is the only method practised in present day obstetrics.

Classical - Here, 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.

Q. What are the indications for a caesarian section?
Ans. Indications are divided in to two categories:

Absolute indications:
Where caesarean section is the only possibility of delivering the fetus safely.

• Previous two caesarean sections
  
• Vaginal atresia (narrowing of the vaginal opening
  
• Advanced carcinoma of the cervix.
  
• Placenta Praevia type IV

Relative indications:
These indications are more common like:

• Contracted pelvis and cephalo-pelvic disproportion is the commonest indication.
  
• Previous caesarean section associated with other risk factors.
  
• Foetal distress during first stage of labour
  
• Abnormal uterine contractions leading to non-progress of labour.
  
• Ante partum haemorrhage - due to placenta praevia or abruptio placenta.
  
• Mal presentations like breech, transverse lie, brow and mentoposterior position of face.
  
• Bad obstetric history
  
• Failed surgical /medication induction
  
• Primigravidae with associated other risk factors.
  
• Uncontrolled diabetes with previous history of foetal wastage
  
• Pelvic tumours such as cervical / broad ligament fibroid, impacted ovarian tumour.

Contraindications of caesarean section in absence of maternal interest are

(a) Dead foetus
(b) Baby is too premature to survive.
(c) Presence of blood coagulation disorders.

Timing of operation can be
(a) Elective: when the operation is done at a prearranged time during pregnancy to ensure best surgical conditions. It is done between 36-38 weeks to deliver a mature baby.

(b) Emergency: when operation is performed in emergency due to unforeseen maternal and foetal complications either during frequency or labour.

Q. What are the complications of caesarian section?
Ans. Complications of caesarian section could be divided into:

• Maternal complications
  
• Foetal complications

Maternal complications

• Primary haemorrhage - excessive blood loss > 1 litre during the operation or following operation.
  
• Shock may occur due to excessive blood loss.
  
• Anaesthetic hazards: like aspiration pnemonia and hypertension.
  
• Infection - in abdominal wound, uterus, peritoreal cavity, urinary tract · Intestinal obstruction.
  
• Leg vein thrombosis and pulmonary embolism due to immobility. So patient is asked to move early.
  
• Wound complication like haematoma, or pus.

Foetal complications

• Increased incidence of respiratory distress syndrome.

Pregnancy following the previous caesarean section

Patient should have regular antental visits with ultra sound and blood investigations. Hospitalization is done at 36 wks in previous classical section and elective caesarean section is done at 38 weeks in these patients as there is increase chance of scar rupture (5%).

Vaginal delivery is attempted if:

• There are no associated complications
  
• The baby is average sized
  
• There is no history of any complications during previous caesrean section.

During vaginal delivery patient is observed for any scar tenderness and progress of labour is meticulously noted.