CASEARIAN SECTION

 INTRODUCTION

It is an operative procedure where by the fetuses after the end of 28 week are delivered throw an incision on the abdominal and uterine wall.

INDICATION 

1. Absolute :- 

•  Central placenta previa 
• Contracted pelvic 
• Pelvic mass 
• Carcinoma of cervix
• Vaginal obstruction 
• 2. Relative
• Cephelo pelvic Dyspraportion (CPD)
• Previous cesarean section 
• Fetal distress 
• Labor dystocia
• Antipartum hemorrhage 
• Failed Surgical induction 
• Back obstetric  history 
• Hypertensive disorder 
• Medical gynecological disorder
• Malpresentation 

TIME OF OPERATION 

1. Elective 

2. Emergency 

1. Elective  :- When the operation is done and a pre arrange time during pregnancy to ensure the best quality of obstetric. 

2. Emergency :- When the operation is perform due to an obstractive emergency time limit of 30 min is through to be reasonable from the time of dicision to stary the procedure. 

TYPE OF OPERATION 

1. Lower segment 

2. Classicle of upper segment 

1. Lower Segment :- In this operation the extraction of the baby is done throw an incision made in the lower segment throw a peritoneal approach. 

2. Classicle Of Upper Segment :- In this operation the baby is extracted throw an incision made in upper segment of the uterus. 

Other 

Lower segment transverse       :         ____

Vertical 

J incision 

Clasicle incision 

INverted T

Caeserian Section :- 

1. Pre Operative 

• Inform written consent should be taken anesthesia and blood transfusion is obtained.
• Abdomen is scrubbed with antiseptic solution .
• Pre medicative sedatives must not be given 
• Renitidine 150 mg is given orally night before and repeat 50 mg 1hr before surgery.
• The stomach should be empty and bladder should be empthy.
• Metocloprimide 10 mg IV is given to increase the tone of esophegial spinter FHS should be choeked. 
• Pediatrition should be available. 

Position Of the Patient 

• Supine with little legs flexed and Patient till toward the left side. 

Antiseptic penting 

• Abdomen is painting with savlon.

Incision On the abdomen 

• Provide incision 

Packing 

• Doyen's retracter 

Uterine Incision 

• Peritonial incision muscle
• Other Incision 
• Lower vertical, Classical Incision, Upper segment, J incision, T incision. 
• Dilivery of the head
• After the delivery of the head, the doyen's retracter is removed. The head is deliverd by hooking head with fingers.
• Delivery of Trunk
• Doyen's retracter is reintroduce.
• Removal of placenta 
• Exploration of the uterine 
• Suturing of the uterine woom. 

Sutring of the uterine bomb. 

1. First Layer:- The suture material is number 0 choromic Catgut a vonineous running suture taking deeper excluding decidua. 

2. Second Layer :- Similar Continueous suturing is placed taking the supperficial muscles by over laping method. 

3. Third Layer :- The peritoneal flex are apposed by contineous inverting sutures ( During Suturing Doyen's retracter is removed before completing the suture.

COMPLICATION

Intra operative :-

• Extraction of urine 
• Uterine lesiration 
• Bladder injury 
• Urethral injury
• GI tract Injury 

Post Operative Complication 

I)