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Caesarean Section Overview and Guidelines

This document discusses different types of operative deliveries including cesarean sections and assisted vaginal deliveries. It describes indications, contraindications, preparation, and potential complications for each type of operative delivery. Types of cesarean sections include transverse lower segment, classical, and cesarean hysterectomy. Assisted vaginal deliveries include vacuum extraction and forceps delivery. Close monitoring is important for trial of vaginal birth after cesarean.

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Mtwe Zakayo
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81 views19 pages

Caesarean Section Overview and Guidelines

This document discusses different types of operative deliveries including cesarean sections and assisted vaginal deliveries. It describes indications, contraindications, preparation, and potential complications for each type of operative delivery. Types of cesarean sections include transverse lower segment, classical, and cesarean hysterectomy. Assisted vaginal deliveries include vacuum extraction and forceps delivery. Close monitoring is important for trial of vaginal birth after cesarean.

Uploaded by

Mtwe Zakayo
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

OPERATIVE

DELIVERY

Mjahiduni Kimu MD
Obstetrics and Gynaecology I (CMT 05104)
Department of Clinical Medicine
Gold Seal Medical College
Definition
• Operative delivery is An alternative
method of delivery that is used when the
mother is unable to give birth normally
(SVD) and needs surgical intervention.
Types of Operative Delivery

a) Caesarean delivery
i. Transverse Lower Segment Caesarean
Section (LSCS)
ii. Classical caesarean section
[Link] hysterectomy
Types of Operative Delivery cont...
b ) Operative vaginal delivery
i. Vacuum
ii. Destructive delivery of a dead foetus.
– Includes the following:
– Craniotomy (dead fetus, 2/5 or less of their head must be
above the brim. If it is higher than this, Caesarean section is
usually safer.
– Head must be impacted.
– Maternal cervix must be at least 7 cm dilated, and preferably
fully dilated.
– Uterus must be unruptured, and not in imminent danger of
rupturing) Baby is dead and is lying transversely, cervix is 8
cm or more dilated, and maternal uterus is not ruptured.
Indications for Caesarean Section

a) Faults with birth canal


 Cephalo pelvic disproportion
 Pelvic tumours
 Previous scars, caesarean section,
perinearaphy, Vesico-Vaginal Fistula
(VVF) and Rectal Vaginal Fistula
(RVF) repair
 Cervical/vaginal stenosis
Indications for Caesarean Section cont...

b ) Foetal malpresentation and lie


 Breech
 Brow
 Face - mental posterior
 Cord presentation/prolapse
 Transverse lie
Indications for Caesarean Section cont...

c ) Abnormalities of labour
 Obstructed labour
 Ante partum Haemorrhage (APH)
 Foetal distress
 Eclampsia
Preparation of the Patient for Caesarean Section

 Obtain informed consent from the patient


 Take blood for haemoglobin and blood
grouping
 IV line for input of fluids
 IV Antibiotics for prophylaxis
 Catheter to monitor urine output
Complications of Caesarean Section
 Bleeding, intra-operative or post-operative
( PPH)
 Shock
 Pain
 Wound infection
 Anaesthetic agents exposure
 Late ambulation post delivery
 Increased risk of thromboembolism
 Surgical complications: injury to bowel,
bladder, etc.
Trial of Scar (Vaginal Delivery after
C/S)
 Providing a pregnant woman with an
opportunity to deliver vaginally, when
she has a previous caesarean scar/history
of C/S
 Close monitoring of labour should be
done using partograph
Indications for Trial of Scar
 Indication for the previous caesarean section should
be non-recurrent
 Healing of the uterine scar was without sepsis
 The previous caesarean should be more than two
years prior to this delivery
 Must be single previous scar
 The foetus must be in cephalic presentation
 Singleton pregnancy
 Adequate pelvis
 Facilities for emergency caesarean must available
Management of a Patient for Trial of Scar

 During trial of scar, the labour progress


should be closely monitored by:
– Scar tenderness
– Pulse rate
– PV bleeding (Bleeding per vaginum)
– Foetal heart rate
Low Cavity Vacuum Extraction (LCVE)
Indications for vacuum delivery
 Delayed second stage
 Foetal distress in second stage
 Maternal conditions: requiring short second
stage ,such as:
i. Severe anaemia
ii. Heart failure
[Link] distress
Prerequisites for vacuum delivery
 Full dilatation of cervix
 Good uterine contractions
 Adequate pelvis
 Normal size of the baby
 Cephalic presentation
 Descent 3/5 or more
 No caput
 No severe moulding
 Avoiding a vaginal operative delivery for a foetus
whose mother is HIV positive is advisable if
possible to minimize trauma to the foetal scalp
which may increase maternal foetal HIV exposure
Prerequisites for Forceps Application
 The head must be engaged.
 The fetus must present as a vertex.
 The position of the fetal head must be
precisely known.
 The cervix must be completely dilated.
 The membranes must be ruptured.
 There should be no suspected cephalic–
pelvic disproportion
Basic rules

 Delivery should be completed within 15


minutes
 Head should descend with each pull
 The cup should be applied no more than
three times
Contraindications of LCVE

 Breech presentation
 Face presentation
 Prematurity
 Any contraindications for Spontaneous
Vaginal Delivery (SVD), e.g. two
previous scars, APH, previous perineal
repair
Complications of Low Cavity Vacuum
Extraction (LCVE)
Maternal:
 Trauma to the genital tract
Foetal:
 Oedema and necrosis of the scalp
 Cephalhaematoma (subperiosteal bleed)
 Intracranial haemorrhage (more common
in premature babies)
THANK YOU

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