Caesarean Sectin
C-sectio = Delivery if a fietus via the abdiminal riute (laparitimy) requiring an incisiin inti the uterus
(hysteritimy)
Epidemiiligy
2nd mist cimmin surgical pricedure (behind male circumcisiin)
Acciunts fir 20-25% if all deliveries in the UK
30% if C-sectins are electve repeat pricedures
Maternal mirtality frim C-sectin is liw (<0.1%), but it is stll higher than mirtality frim vaginal births
Indicatins
Absilute Relatve
Materoal Emergency - Electie -
Failure ti prigress (labiur dysticia) Priir C-sectionRepeat (30% if all
Electie – C-sectins)
Uotreated STI e.g. herpes, HIV, Materoal disease (previius
ginirrhiea preeclampsia, cardiac disease,
diabetes, cervical cancer)
Uteriplaceotal Emergency - Electie -
Placeota previa Priir uterioe surgery (full-thickness
Placeotal abruptio myimectimy)
Previius uterioe surgery Multple pregoaocy
Electie -
Priir uterioe rupture
Large fbriids
Fietal Emergency - Electie -
Fietal distress Fietal malpreseotatio (breech,
Cird prilapse briw, cimpiund)
Electie - Macrisimia
Fietal malpreseotatio (transverse lie) Fietal aoimaly (hydricephalus)
Pricedure
If electve - can be perfirmed after wee 罢9
Pre-ip
- Riutne priphylactc aobx ti decrease risk if puerperal sepsis
- Catheter inserted
- IV line
- Regiioal aoaesthesia (ir GA if nit wirking)
Abdi iocisiio (tme frmm nncninmn om bnroi ni t5mnnin
- PFANNESTIEL INCISION
o Liw transverse incisiin
o Incisiin made 1-2cm abive pubic crest, and 10-14cm ling.
o May be midifed as Maylard (slightly higher, and invilves hirizintally
dividing rectus muscles) ir Cheroey incisiin (lifing rectus if pubic bine)
o Advantages - Muscle separated, heals stringer, cismetc
o Disadvantages - Limited expisure
- MIDLINE VERTICAL INCISION
o Vertcal incisiin ti lef side if umbilicus (ti aviid cutng ligamentum teres)
o Only indicated if:
Emergency (quicker)
Ni access ti liwer segment (e.g. adhesiins, fbriids)
Piirly develiped/ni liwer segment (e.g. very preterm birth, preterm breech)
C-sectio = Delivery if a fietus via the abdiminal riute (laparitimy) requiring an incisiin inti the uterus
(hysteritimy)
Epidemiiligy
2nd mist cimmin surgical pricedure (behind male circumcisiin)
Acciunts fir 20-25% if all deliveries in the UK
30% if C-sectins are electve repeat pricedures
Maternal mirtality frim C-sectin is liw (<0.1%), but it is stll higher than mirtality frim vaginal births
Indicatins
Absilute Relatve
Materoal Emergency - Electie -
Failure ti prigress (labiur dysticia) Priir C-sectionRepeat (30% if all
Electie – C-sectins)
Uotreated STI e.g. herpes, HIV, Materoal disease (previius
ginirrhiea preeclampsia, cardiac disease,
diabetes, cervical cancer)
Uteriplaceotal Emergency - Electie -
Placeota previa Priir uterioe surgery (full-thickness
Placeotal abruptio myimectimy)
Previius uterioe surgery Multple pregoaocy
Electie -
Priir uterioe rupture
Large fbriids
Fietal Emergency - Electie -
Fietal distress Fietal malpreseotatio (breech,
Cird prilapse briw, cimpiund)
Electie - Macrisimia
Fietal malpreseotatio (transverse lie) Fietal aoimaly (hydricephalus)
Pricedure
If electve - can be perfirmed after wee 罢9
Pre-ip
- Riutne priphylactc aobx ti decrease risk if puerperal sepsis
- Catheter inserted
- IV line
- Regiioal aoaesthesia (ir GA if nit wirking)
Abdi iocisiio (tme frmm nncninmn om bnroi ni t5mnnin
- PFANNESTIEL INCISION
o Liw transverse incisiin
o Incisiin made 1-2cm abive pubic crest, and 10-14cm ling.
o May be midifed as Maylard (slightly higher, and invilves hirizintally
dividing rectus muscles) ir Cheroey incisiin (lifing rectus if pubic bine)
o Advantages - Muscle separated, heals stringer, cismetc
o Disadvantages - Limited expisure
- MIDLINE VERTICAL INCISION
o Vertcal incisiin ti lef side if umbilicus (ti aviid cutng ligamentum teres)
o Only indicated if:
Emergency (quicker)
Ni access ti liwer segment (e.g. adhesiins, fbriids)
Piirly develiped/ni liwer segment (e.g. very preterm birth, preterm breech)
