Caesarean Section and post –operative care

Dr Isameldin Elamin MD DOWH MBBSAssistant Professor Obstetrics & Gynaecology

Definition of Caesarean Section

• It is an operative procedure to deliver a fetus by making incisions in the abdomen and uterus of the mother.

Caesarean Section• Common indications ( reasons for delivery by

Caesarean Section).– Previous history of Caesarean Section.– Abnormal progress of labour.– Fetus is in distress or hypoxic.– Bony pelvis is too small for the baby to be

delivered by vaginal route.– Any part of the baby other than the head is in the

lower part of the uterus- called Malpresentation.– Failure in inducing labour pains( failed induction).– Bleeding from the uterus before delivery of the

baby.

Procedures for performing a Caesarean section

• Preoperative actions• Confirm that Caesarean Section is required.– Take consent from patient after full explanation of

the procedure and the possible risks.– Reassure the patient and relatives.– Give antacids to reduce acidity in the stomach and

the chance of vomiting.– Inj Ranitidine 50 mg IV one hour before the procedure,– Inj Metoclopramide 10 mg IV one hour before the

procedure.– Stomach should be empty.– Urinary bladder should be catheterized.– Fetal presentation, position and FHS should be

checked.

Anaesthesia and position

• Anaesthesia ( details in next lecture)– Spinal anaesthesia.– Epidural anaesthesia.– General Anaesthesia.

• Position– Dorsal position ( patient lying on her back)– 15 degree lateral tilt to prevent compression of big

veins in the abdomen (inferior venacava) may be given.

Steps of the Caesarean Section operation

• Abdominal cleaning and draping• Abdominal incision- two types:

– Transverse • Post operative pain is less.• Less chance of wound dehiscence or incisional hernia.• Cosmetically better.

– Vertical midline below the umbilicus• Rapid entry into abdomen is possible• Incision can be extended.• Blood loss minimal.

Skin is incised transversely.

Uterus is incised

Baby’s head is being delivered.

Placenta is removed and uterus sutured.

Post Operative Care

• Nil by mouth for 4hrs after the completion of operation.

• Intra venous fluids for 24 hrs.

• Antibiotics as per hospital policy.

• Drugs like Pethidine, Diclofenac for relief of pain.

• Care of the bladder- remove urinary catheter after 6 hours, and then encourage the patient to pass urine normally.

Post Operative Care..• Monitor-

– Level of consciousness.– Vital parameters- Pulse, BP, respiration, temp.– Amount of bleeding through the vagina.– Urine output and state of hydration

• Encourage early breast feeding- it is very good for both the baby and mother.

• Can give her sips of water after 4 hrs. If there is no vomiting , then liquid diet like juice, tea , soup etc. can be given.

• Movements of limbs & deep breathing exercises to prevent Deep Vein Thrombosis / Pulmonary Embolism should start from the morning of the 1st post -operative day .

Post Operative Care ..• Semi solids & solid food can be started if bowel sounds are good

and the patient has passed flatus (gas) or stools.

• Early ambulation is important to prevent pulmonary complications and deep vein thrombosis.

• Can be discharged from hospital after 96 hrs.

• Usually these days absorbable sutures are used- they don’t need removal.

• Advise her to:– Come for follow up check up after 2 weeks along with the baby.

– Avoid severe exertion and lifting heavy weights for about 3 months.

– Use contraceptive methods to delay the next pregnancy for about 2

years.

Caesarean Section : Possible Complications• Haemorrhage- during and after operation.

• Sepsis- of the uterus, peritoneum, septicemia.• Anaesthetic complications - hypoxia, aspiration,

pneumonia.

• Thrombo–embolism- DVT, pulmonary embolism.• Wound complications- infection, disruption.• Late complications:

– Incision hernia– Problems in future pregnancies

• Rupture of the scar in the uterus.• Need for repeat Caesarean delivery.

VIDEO OF C/S