CESAREAN SECTION / LSCS
A cesarean section is an operative operation that involves making abdominal and uterine incisions to deliver a healthy fetus or more.
If there is a risk to either the mother or the infant, an immediate cesarean operation is performed.
When the parents wish to deliver their infant on a particular date and period, they should decide for an elective cesarean operation, which is administered after the baby’s maturity is measured.
A lower (uterine) part caesarean section is the most common form of cesarean section today (LSCS). It necessitates a transverse cut immediately over the bladder’s tip, resulting in less blood loss and a faster healing period than other Cesarean sections.
In the following cases, it may be transverse (the most common) or vertical:
- Presence of lateral varicosities
- Constriction ring to cut through it
- Deeply engaged head
An LSCS’s position is favorable for the following reasons:
- Peritoneum is more loosely attached to the uterus
- Contraction is less than in upper part of uterus
- Healing is more efficient
- Sutures are intact (less problem with suture loosening)
Indications for Cesarean section:
- Prior classical C-section
- Active genital herpes infection
- Cervical carcinoma
- Maternal trauma/demise
Fetal and Maternal factors:
- Cephalopelvic disproportion
- Placenta previa
- Placenta abruption
- Failed operative vaginal delivery
- Post-term pregnancy
- Fetal malposition
- Fetal distress
- Cord compression
- Erythroblastosis fetalis
Contraindications of Cesarean section:
- A dead fetus is a dead fetus in rare situations of pelvic contracting, ignored elbow, or severe unintentional hemorrhage.
- DIC (disseminated intravascular coagulation) is a form of coagulation that happens in the body (DIC).
- There is a large scar on the abdominal wall or a pyogenic infection.
- Anaesthesia: Typically administered under spinal anesthesia, but rarely under general anesthesia, as in the case of Eclampsia or Extreme Cat. A wedge or blanket is used to tip the patient 10 to 15 degrees to the left. This is intended to keep her uterus from compressing her vena cava (supine hypotensive syndrome)
- Cleansing and Draping: To stop surgical site contamination, the skin should be cleansed, preferably with Povidone-iodine 7.5 percent. Where at all practicable, non adhesive drapes should be used to drape the surgical site. These have been related to a lower risk of wound infection as comparison to adhesive drapes.
- Abdominal incision: As compared to a vertical incision, a transverse skin incision is associated with less postoperative discomfort and is more aesthetically pleasing to patients (classic). The Pfannenstiel incision is curved and 2 to 3 cm above the symphysis pubis. The incision should usually require 15 cm of exposure. The skin and subcutaneous fat are separated using electrocautery.
- Uterine incision: The anterior rectus sheath is transversely incised. In the midline, the rectus muscles are separated. The peritoneum of the parietal lobe is opened. The loose peritoneum covering the lower uterine segment is fixed in place and incised semilunarly for around 10 cm, with the edges pointing upwards. Through a Doyen’s retractor, the bladder is dissected backward and retracted over the symphysis. Toothed or Kocher’s forceps are used to rupture membranes.
- Delivery of the infant: The head is delivered by carefully positioning the right hand under it and raising it up with the aid of fundal pressure exerted by the assistant, one blade of the forceps, or Wrigley’s forceps. An assistant will drive the head up vaginally if it is deep in the pelvis. After applying the hand or forceps blade and before removing the head, the Doyen’s retractor is extracted. Before the arrival of the head, the foetus is suctioned. The foetus is removed in the breech or transverse lying position. After the umbilical cord has been clamped and cut, it’s time to deliver the placenta through spontaneous extraction. Oxytocin is used to strengthen uterine contractions, and the cord is gently twisted. On one side, the uterus is inspected for any remaining membranes or placental tissue, and the placenta is tested to ensure it is complete. The uterus is then massaged to induce contractions. The hormone oxytocin is used to contract and involute the uterus.
- Closing the uterus: The uterine incision is closed in three layers. The first is a continuous locking suture that takes the bulk of the myometrium but does not move into the decidua to avoid endometriosis and scar weakness. The second inverts the first layer and is either continuous or interrupted. The third layer is a continuous or interrupted layer that closes the fetus’ visceral peritoneum. Similarly, the rectus muscles are not reattached surgically. The skin is closed with a subcuticular suture after the fascial tissue is carefully closed to provide good wound strength.
- Closing the incision: After that, the intestine is closed in layers.
- During operation:
- Uterine atony
- Bladder injury
- After operation:
- Infections: Endometriosis, Wound infection or dehiscence
- Abdominal wall hematoma
- Urinary tract infection