2. Cesarean Section (CS)
Delivery of a fetus through an abdominal
incision followed by incision of the uterine
wall. Definition does not include removal
of fetus from abdominal cavity after uterine
rupture or in an abdominal pregnancy.
3. Reasons for increasing CS rates:
1. Safety of the operation
2. Delivery of breech by CS
3. Fear of uterine rupture after previous CS
4. Fetal distress as indication and increased
use of electronic fetal monitor
5. More preference to CS than operative
vaginal deliveries, particularly midforceps
4. Reasons for increasing CS rates:
6. Increasing age of marriage and childbearing,
hence more elderly primiparas
7. Use of technology like ultrasound and fetal
monitoring
5. Phil./ Local Indications for CS:
1. Obstructed labor
2. Hemorrhagic complications
3. Abnormal patterns of labor
4. Fetal distress
5. Previous CS (34%)
6. Cord complications
7. Obstetric problems
6. Vertical Incision
An infraumbilical midline vertical incision
begins 2 to 3 cm above the superior margin of the symphysis
estimated fetal size, and 12 to 15
small opening is made sharply with scalpel in the upper half
of the linea alba
Index and middle fingers are placed beneath the fascia, and
the fascial incision is extended superiorly and inferiorly with
scissors or scalpel.
Midline separation of the rectus muscles and pyramidalis
muscles and peritoneal entry
7. Hysterotomy
lower uterine segment is incised transversely –
Kerr
low-segment vertical incision - Krönig
classical incision is a vertical incision into the
body of the uterus above the lower uterine
segment and reaches the uterine fundus
8. Maternal mortality from CS is due to
underlying diseases rather than
surgery
itself, except those cases due to
infection.
9. Mortality rate associated with Cesarean
Section is very low. CS at present is
considered a safe operation.
10. Some Maternal Complications
1. Injury to neighboring organs: urinary bladder,
ureters, bowels, blood vessels in broad
ligaments and uterine blood vessels;
2. More risk of postpartum hemorrhage
3. More risk of pulmonary embolism,
4. Paralytic ileus
5. Infection – wound infection, UTI
11. Perinatal mortality associated with CS
depends on maternal complications or
conditions for which CS is done, condition
of fetus before surgery and age of gestation.
12. Vaginal Birth After Cesarean (VBAC)
one way to lower CS rates
Limited to cases where uterine incision
is low transverse and no extension of
the wound (previous CS of one low-segment
incision), after excluding inadequate pelvis.
13. Advantages of VBAC
1. Vaginal births are associated with lower rate
of infection and blood loss compared to CS.
2. Babies born vaginally undergo a natural
squeeze to expel fluid from esophagus, nose
and lungs.
3. Hysterectomy is one of greatest risk of CS
4. Recovery time is faster after vaginal birth.
5. Hospital stay is shorter.
