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Epidemiology
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History
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Types
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Indications
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Techniques
Hx of c/d
def.
l birth of a baby throu abd. N uterine incision after d age of
viability.
Hx
c/s is tautology -------c/d or c/b
latin verb caedere----to cut
roman law lex regis, later call lex ceserea, 18th century bc
1st successful c/d ,swiss pig farmers wife [mrs jacoub nufer]
munro kerr popularised lscd
Types of c/d
1. By timing
elective
emergency
2. By incision
classical
lower segment
transverse
j-shape
inverted t shape
longitudinal [de lee ]
Indication - maternal
2 previous c/d
Previous utrine rupture
Previous breeching of endometrium
Severe pre-eclampsia/eclampsia with unfavourable cx
Previous vaginal injuries/surgery
3rd degre perineal tear/repair
vvf repair/rvf repair
acquired gynaetresia
Long hx of 1o or 2o infertility
Fetal
cord
prolapse
fetal
distress
malpresentation/abnormal
lie
fetal
macrosomia
fetal
abnormalities
Matrno-fetal
cpd
failure
to progress
Placental
abruptio
placenta ; placenta previa
Technique of c/d
Universal precautions
General principles
asepsis
minimal/gentle tissue handling
good heamostasis
eradicate dead space
avoid excessive suture material
re-approximation of layers without stragulation of the tissue
minimizing amt. Of desensitized tissue
Pre-op. Preparation
optimize the pt.
position of the pt.
maintain lateral tilt 10- 15o
using a wedge during transfer to the theatre
catheterization
preparation of skin
Misgav ladach method
Skin incison 15cm long
joel cohen
Uterine incision
Delivery of the fetus
3—8 min after induction
30 – 180 sec.after uterine incision
Delevery of the placenta
Exteriorization of the uterus
reduce bld loss b/cos of traction
facilitates uterine suturing
Closure
Complications
immediate
pph
Injuries to adjoing structures, u.b.,intestine
Intermediate
Wound sepsis
Wound breakdown
Endometritis
Peritonitis
Long term
Dehiscence or rupture of uterine scar
Subsequent 2o infertility due to severe intratubal n peritubal adhesion
Conclusion
In a number of ways d technique of c/d have undergone modifications,
largely based on a developing evidence base. Anticipation,preparation, adequate
traning n earlier snr involvement in complex cases will help to achieve better
results.further studies should be encouraged to improve safety, reduce
morbidity n cut costs.