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.