Nomenclature:
- It's name it appears that the operation derives its name from the notification ‘lex Cesarea’ – a Roman law promulgated in 715 BC which was continued even during Caesar’s reign.
-The operation does not derive its name from the birth of Caesar, as his mother lived long time after his birth. The other explanation is that the word cesarean is derived from the Latin Verb ‘Cedere’ which means ‘to cut’.
-French obstetrician, Francois Mauriceau first reported cesarean section in 1668.
#Obs_Gyne
- It's name it appears that the operation derives its name from the notification ‘lex Cesarea’ – a Roman law promulgated in 715 BC which was continued even during Caesar’s reign.
-The operation does not derive its name from the birth of Caesar, as his mother lived long time after his birth. The other explanation is that the word cesarean is derived from the Latin Verb ‘Cedere’ which means ‘to cut’.
-French obstetrician, Francois Mauriceau first reported cesarean section in 1668.
#Obs_Gyne
Absolute indications of CS:
Vaginal delivery is not possible. Cesarean is needed even with a dead fetus.
Indications are few:
-Central placenta previa
-Contracted pelvis or cephalopelvic disproportion (absolute)
-Pelvic mass causing obstruction (cervical or broad ligament fibroid)
-Advanced carcinoma cervix
-Vaginal obstruction (atresia, stenosis).
#Obs_Gyne
Vaginal delivery is not possible. Cesarean is needed even with a dead fetus.
Indications are few:
-Central placenta previa
-Contracted pelvis or cephalopelvic disproportion (absolute)
-Pelvic mass causing obstruction (cervical or broad ligament fibroid)
-Advanced carcinoma cervix
-Vaginal obstruction (atresia, stenosis).
#Obs_Gyne
Common Indications of CS:
Primigravidae:
(1) Failed induction
(2) Fetal distress (nonreassuring fetal FHR)
(3) Cephalopelvic disproportion (CPD
(4) Dystocia, nonprogress of labor
(5) Malposition and malpresentation (occipitoposterior, breech).
(6) On maternal request
Mutigravidae:
(1) Previous cesarean delivery
(2) Antepartum hemorrhage (placenta previa, placental abruption)
(3) Malpresentation (breech, transverse lie).
#Obs_Gyne
Primigravidae:
(1) Failed induction
(2) Fetal distress (nonreassuring fetal FHR)
(3) Cephalopelvic disproportion (CPD
(4) Dystocia, nonprogress of labor
(5) Malposition and malpresentation (occipitoposterior, breech).
(6) On maternal request
Mutigravidae:
(1) Previous cesarean delivery
(2) Antepartum hemorrhage (placenta previa, placental abruption)
(3) Malpresentation (breech, transverse lie).
#Obs_Gyne
Quick Notes
TIME OF OPERATION: -Elective -Emergency.
Elective:
-When the operation is done at a prearranged time during pregnancy to ensure the best quality of obstetrics, anesthesia, neonatal resuscitation and nursing services.
Time:
-Maturity is certain: The operation is done about 1 week prior to the expected date of confinement.
-Maturity is uncertain: Ultrasound assessment in first or second trimesters if available is corroborated.
Amniocentesis for L:S ratio is used to ensure fetal maturity. Otherwise spontaneous onset of labor is awaited and then CS is done.
#Obs_Gyne
-When the operation is done at a prearranged time during pregnancy to ensure the best quality of obstetrics, anesthesia, neonatal resuscitation and nursing services.
Time:
-Maturity is certain: The operation is done about 1 week prior to the expected date of confinement.
-Maturity is uncertain: Ultrasound assessment in first or second trimesters if available is corroborated.
Amniocentesis for L:S ratio is used to ensure fetal maturity. Otherwise spontaneous onset of labor is awaited and then CS is done.
#Obs_Gyne
Quick Notes
Elective: -When the operation is done at a prearranged time during pregnancy to ensure the best quality of obstetrics, anesthesia, neonatal resuscitation and nursing services. Time: -Maturity is certain: The operation is done about 1 week prior to the…
•Benefits and risks of elective operation:
-Reduction in perinatal morbidity and mortality as there is no hazard from labor and delivery process.
-Maternal benefits:
No pelvic floor dysfunction.
•Maternal risks are:
-Longer recovery time and hospital stay.Risks of placenta previa and hysterectomy are more in subsequent delivery.
#Obs_Gyne
-Reduction in perinatal morbidity and mortality as there is no hazard from labor and delivery process.
-Maternal benefits:
No pelvic floor dysfunction.
•Maternal risks are:
-Longer recovery time and hospital stay.Risks of placenta previa and hysterectomy are more in subsequent delivery.
#Obs_Gyne
Quick Notes
TIME OF OPERATION: -Elective -Emergency.
Emergency:
-Category of CS (NICE): Emergency:
-When the operation is to be done due to an acute obstet ric emergency (fetal distress).A time interval of 30 minutes between the decision and delivery is taken as reasonable.
•Category 1:
-When there is immediate threat to the life of the woman or the fetus.
-Decision delivery interval should be 30 minutes.
•Category 2:
-When there is maternal or fetal compromise which is not immediately life-threatening.
-CS should be done within 75 minutes of making decision.
•Category 3:
-There is no maternal or fetal compromise but needs early delivery.
•Category 4:
-Delivery is planned to suit the woman, family members and the hospital staff.
#Obs_Gyne
-Category of CS (NICE): Emergency:
-When the operation is to be done due to an acute obstet ric emergency (fetal distress).A time interval of 30 minutes between the decision and delivery is taken as reasonable.
•Category 1:
-When there is immediate threat to the life of the woman or the fetus.
-Decision delivery interval should be 30 minutes.
•Category 2:
-When there is maternal or fetal compromise which is not immediately life-threatening.
-CS should be done within 75 minutes of making decision.
•Category 3:
-There is no maternal or fetal compromise but needs early delivery.
•Category 4:
-Delivery is planned to suit the woman, family members and the hospital staff.
#Obs_Gyne
Quick Notes
TYPES OF OPERATIONS: -Lower segment -Classical or upper segment. #Obs_Gyne
1-Lower segment cesarean section (LSCS):
-In this operation, the extraction of the baby is done through an incision made in the lower segment through a transperitoneal approach.
-It is the only method practiced in present day obstetrics and unless specified, cesarean section means lower segment operation.
#Obs_Gyne
-In this operation, the extraction of the baby is done through an incision made in the lower segment through a transperitoneal approach.
-It is the only method practiced in present day obstetrics and unless specified, cesarean section means lower segment operation.
#Obs_Gyne
Quick Notes
TYPES OF OPERATIONS: -Lower segment -Classical or upper segment. #Obs_Gyne
Classical:
-In this operation, the baby is extracted through an incision made in the upper segment of the uterus.
-Its indications in present day obstetrics are very much limited and the operation is only done under forced circumstances, such as:
•Lower segment approach is difficult:
1) Dense adhe sions due to previous abdominal operation;
2) Severe contracted pelvis (osteomalacic or rachitic) with pendulous abdomen.
•Lower segment approach is risky:
1) Big fibroid on the lower segment blood loss is more and contemplating myomectomy may end in hysterectomy.
2) Carcinoma of cervix
3) Repair of high VVF
4) Complete anterior placenta previa with engorged vessels in the lower segment—risk of hemorrhage.
•Perimortem cesarean section:
It is done to have a live baby (rare):
Perimortem section is an extreme emergency procedure.
#Obs_Gyne
-In this operation, the baby is extracted through an incision made in the upper segment of the uterus.
-Its indications in present day obstetrics are very much limited and the operation is only done under forced circumstances, such as:
•Lower segment approach is difficult:
1) Dense adhe sions due to previous abdominal operation;
2) Severe contracted pelvis (osteomalacic or rachitic) with pendulous abdomen.
•Lower segment approach is risky:
1) Big fibroid on the lower segment blood loss is more and contemplating myomectomy may end in hysterectomy.
2) Carcinoma of cervix
3) Repair of high VVF
4) Complete anterior placenta previa with engorged vessels in the lower segment—risk of hemorrhage.
•Perimortem cesarean section:
It is done to have a live baby (rare):
Perimortem section is an extreme emergency procedure.
#Obs_Gyne
Anticoagulation during pregnancy:
• In mechanical valve prosthesis:
- First trimester: warfarin if daily dose is 5 mg or less, or unfractionated heparin (IV) or LMWH (anti-factor 10 adjusted).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR)
- From week 37 till term: UFH (IV).
• In AF or in venous thromboembolism:
- First trimester: warfarin (if daily dose is 5 mg or less), UFH (IV or SC), or LMWH (weight-based).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR), UFH (SC), or LMWH (weight-adjusted).
- From week 37 till term: UFH (IV).
#Obs_Gyne
• In mechanical valve prosthesis:
- First trimester: warfarin if daily dose is 5 mg or less, or unfractionated heparin (IV) or LMWH (anti-factor 10 adjusted).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR)
- From week 37 till term: UFH (IV).
• In AF or in venous thromboembolism:
- First trimester: warfarin (if daily dose is 5 mg or less), UFH (IV or SC), or LMWH (weight-based).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR), UFH (SC), or LMWH (weight-adjusted).
- From week 37 till term: UFH (IV).
#Obs_Gyne
Quick Notes
Anticoagulation during pregnancy: • In mechanical valve prosthesis: - First trimester: warfarin if daily dose is 5 mg or less, or unfractionated heparin (IV) or LMWH (anti-factor 10 adjusted). - Second and early third trimesters: warfarin (whatever the…
This is according the American college of chest physicians "ACCP"!!
BIOPHYSICAL:
Principle—Biophysical profile is a screening test for uteroplacental insufficiency.
-The fetal biophysical activities are initiated, modulated and regulated through fetal nervous system.
-The fetal CNS is very much sensitive to diminished oxygenation. Hypoxia → metabolic acidosis → CNS depression → changes in fetal biophysical activity.
#Obs_Gyne
Principle—Biophysical profile is a screening test for uteroplacental insufficiency.
-The fetal biophysical activities are initiated, modulated and regulated through fetal nervous system.
-The fetal CNS is very much sensitive to diminished oxygenation. Hypoxia → metabolic acidosis → CNS depression → changes in fetal biophysical activity.
#Obs_Gyne