CAESAREAN SECTION

When properly applied, caesarean section is an important operation in reducing maternal and perinatal mortality and morbidity.

The major indications for caesarean section are:

  • Cephalopelvic disproportions (CPD)
  • Foetal distress
  • Previous caesarean section: 2 or more caesarean sections or 1 caesarean section with CPD
  • Malpresentations: Breech, transverse lie
  • Cord prolapse or presentation
  • Antepartum haemorrhage
  • Placenta praevia (major types), placental abruptions (sometimes)
  • Hypertensive disease: Where induction is unlikely to succeed or is contraindicated

Types of caesarean section operation:

  • Lower uterine segment transverse incision – Routinely done nowadays because of its low morbidity and safety during subsequent pregnancies.
  • Classical caesarean section – Vertical incision in upper uterine segment; done very rarely for:
    • Inaccessible lower segment because of tumours or adhesions
    • Avoiding dissemination in cancer of cervix
    • Impacted shoulder presentation

Preparation for caesarean section and procedure:

  • Catheterization of the bladder inserted in the theatre.
  • Empty the stomach (if not fasted).
  • Premedicate with atropine IM 0.6mg half an hour before operation and start antibiotics at a high dose crystalline penicillin 5 mega units for a clean operation and ceftriaxone 1g STAT if infection is suspected.
  • Cross-match 1–2 units of blood, fix drip normal saline 500ml over 8 hours (15 drops per minute).
  • Anaesthesia may be general or regional; requires special skills to avoid foetal respiratory depression and maternal gastric acid aspiration.
  • Preparation of operation field done when mother is awake to shorten induction delivery interval to 10 minutes or less.
  • Incision through the abdomen and uterus done quickly (but carefully) to avoid foetal respiratory depression.

Post operative care after caesarean section:

  • Patient requires:
    • IV fluids normal saline 500ml alternate with 5% dextrose 500ml every 6 hours for 24 hours,
    • Analgesia morphine IM 10mg every 4 hourly if required and give antibiotics if indicated ceftriatoxe 1g OD 3 days.
    • Close observation, vital signs, BP, temp, pulse, respiration half hourly for the first hour or until awake and then monitor every 4 hours.
  • Early postoperative ambulation is encouraged.
  • Chest and leg exercises are also given to prevent hypostatic pneumonia and deep venous thrombosis (DVT).
  • Patient can be discharged from 4 to 7 days.
  • Alternate stitches are removed on the 6th day and all stitches on the 7th day.