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CAESAREAN SECTION,[object Object]
INTRODUCTION,[object Object],An operative procedure that is carried out under anesthesia whereby the fetus, placenta and membranes are delivered through an incision in abdominal wall amd the uterus,[object Object],Usually carried out after viability has been reached i.e. 24-48 weeks of gestation onwards.,[object Object]
The first operation performed on a women is referred to as a primary caesarean section. ,[object Object],When operation is performed in subsequent pregnancies,it is called repeat caesarean section.(C/S),[object Object]
INCIDENCE:,[object Object],The incidence of caesarean is steadly raising.,[object Object],During the last decade there has been two-three folds rise in the inciddence from the initial rate of about 10%.,[object Object],Factors responsible are increased safety of operation due to improved anesthesia, availability of blood transfusion and antibiotics. ,[object Object],Increased awareness of fetal well being and idenification of risk factors have caused reduction of difficult operation or manipulative vaginal deliveries.,[object Object]
Indication for Caesarean section,[object Object],1. Absolute:,[object Object],Vaginal Atresia,[object Object],Advanced carcinoma of cervix,[object Object],Cervical or broad of contracted pelvis.,[object Object],Severe degree of contracted pelvis.,[object Object],2. Relatives:,[object Object],Cephalopelvic disproporton,[object Object],Previous uterine scar,[object Object],Fetal distress.,[object Object],Malpresentations,[object Object],Antepartum hemorrhage,[object Object],Elderly primigravidae,[object Object],Chronic hypertension,[object Object],Diabetes,[object Object],Pelvis atresia,[object Object]
3.Fetal indicaton:,[object Object],Fetal distress,[object Object],Umbilical cord prolapse,[object Object],Macrosomia,[object Object],Placental insufficiency,[object Object],Multiple pregnancy,[object Object]
Contraindication:,[object Object],Dead fetus,[object Object],Baby is too much premature,[object Object],Presence of blood coagulation disorder,[object Object]
Time of operation:,[object Object],Elective caesarean section:,[object Object],The term elective indicates that the decision to deliver the baby by caesarean has beenmade during the pregnancy anh before the onset of labour. ,[object Object],It means pre-planning for doing caesarean section.,[object Object],Indication:,[object Object],[object Object]
Placenta previa
Bad obstetric history,[object Object]
Uterine rupture
Eclampsia
Prolonged first stage of labour
Abnormal uterine contraction
Placenta previa diagnosed in labour.,[object Object]
Classical caesarean section:,[object Object],In this baby is extracted through an incision made in upper segment of uterus. ,[object Object],Is rarely performed.,[object Object],Operation is done only under forced circumstances, such as:,[object Object],[object Object]
Big fibroid on lower segment
constriction ring
lower segment is difficult or risky example:placenta previa, adhesion due to previous abdominal operation.,[object Object]
Operation procedure:,[object Object],The non gravid uterus is a pelvic organ closely covered by a layer of pelvic peritoneum. ,[object Object],As pregnancy advances, the uterus grows up into the abdomen and this peritoneum rises up with the uterus and comes into contact with the abdominal peritoneum. Each of these layers must be incision and repaired.,[object Object],The abdominal peritoneum is situated below the abdominal muscles layer.,[object Object],The anatominal layers are:,[object Object],Skin,[object Object],Fat,[object Object],Rectus sheath ,[object Object],Rectus abdominis,[object Object],Abdominal peritoneum,[object Object],pelvic peritoneum,[object Object],Uterine muscles,[object Object]
The operation most commonly carried out is the lower segment caesarean section.,[object Object],The lower segment incision is in the less muscular and active part of the uterus and heals better.,[object Object],The main reason for preferring the lower uterine segment technique is the reduced incidence of dehiscent pregnancy.,[object Object],The abdomen is opened and the loose folds of the peritoneum over the anterior aspect of the lower uterine segment and above the bladder is incised. The operator continues so incise this further to visualize the fundus of bladder which is then pushed down and away from the surgeon. ,[object Object]

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Caesarean section