LSCS

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Definition Nomenclature

Incidence Factors section


forrisingc
Types differentincisions

Indications each
of
5 Timing
ofoperation
6 NICEcategory

7 Benefits Risks Cesarean


of
8 classical vs LSCS

9
Why Pfannenstiel ispreferred

10 Pre
op
11 Procedure

12 Post
opcare
13 complications

1 Definition

Anoperativeprocedure todeliver the fetusafter28weeksofgestationthrough


an incision through abdominal wall uterus

Lex cesarea

2 Incidence 10151 optimum Robson'sclassification

FactorsResponsible

i Identification high risk pregnancy


of
ii Identificationofhigh risk fetus

electronic
iii use
of fetalmonitoring diagnosis offetaldistress
iv incidence maternalmedicalcomplic GDM PIH 35yearsage
of
v incidence
of operativevaginaldelivery
vi incidence
of assisteddelivery
Vii Fear case
of medicoligal

3
Types
Lowersegment CS classical Cs

not commonlypractised in modernobs

onlyindications
Kerr Uterusadherent tobladder

ii Morbidlyadherentplacenta previa
iii Severlycontractedpelvis

Ms iv Pretermdelivery is not formed

adf.IE ii v cervicalca pelvic tumor


I Schroeder
g vi transverse lie

1
Sanger
Inverted
4 Indications ofLSCS

Absolute common

1 contractedPelvis 1 Fetaldistress
2 CPD 2 Failed induction
3 Pelvicmass fibroid 3 Dystocia non
progressivelabor
4 Advanced Cacomin 4 Malpresentation Malposition

Vaginalobstruct atresia
5 stenosis 5 Obstructed labor

6 3
previous LSCS
6 Elective
7 Previous classical CS
8 Dead Fetus

Relative
1 APH

2 Malpresentation

3 Bad obstetric history Recurrentpregnancyloss

4 Hypertensivedisorders

5 Medical Condn_ HeartdisordersGDM

5 Timingofoperation
sweekpriortodate
whtwain confinement

Elective is
uncertain Ratio I waittillspontaneous
Maturity
onset labor thenCS
of
6 NICE category

category 2 immediatethreatto M F within30mins

decision todeliverytime

category 2 M Fcompromise noimmediatethreat

D Dtime 75 mins

Category 3 No M Fcompromise needsearlydelivery

Planned to suiteveryone 39weeks


Category 4

if before administer steroids

7 Benefits Risk Cesarean section


of

IncreasedRisk in subsequentpregnancies
of complications
1 Abortion 6 Uterinerupture

2 Ectopic Adhesions
pregnancy 7 PPH
3 Pretermdelivery irritateduterus

4 Morbidly Adherentplacenta
5 Placentaprevia
8 Classical vs lower segment c section

9 Pfannested skin incisionpreferred


1 Cosmeticvalue Disadvantages

2 incisionalhernia i longertime

3 wounddehiscence 2 Bloodloss

4 Post more 3 unsuitableforclassicalsection


opcomfort
5 Fundus can be palpated

6 MIDLINESKIN INCISION
interference i respiration
i Quickentry
Stronger ii Moreexposure
iii Bleeding
iv Nervedamage
10 Pre
op
1 Informedconsent

2 NBM

3 PPI H2blocker overnight I hr beforesurgery

4 Foley'scatheter

5 Antibiotics 1hrbefo
Cefazolin2mg IV singledose Penicillin Clindamycin Gentamycin

6 Abd scrubbed i soap

7 Check FHS neonatologist

8 Blood cross check

9 IV cannula RL NS

Operative

1 AntisepticPainting 7.5.1 Povidone Iodine

draping

2 Anaesthesia
Spinal Tq
General LSCS
Emergency

PIH Preeclampsia
S IntracardiacShunt
HOCM
EjectionFraction
PulmonaryHTN
OPERATIVE STEPS
Oxytocin LOU 0.2mg Methergine
1
afterdelivery
2 Delayed cordclamping
3 Removal
ofplacenta by controlledcordtraction

12 Post care
op
1 Observation check vitals 6 8here
2 IV
fluids
3 Oxytocin 5 IV
Oxytocin
4 Analgesics Pethidine
5 Antibiotics

6 Breastfeeding 3.4 his later

7 Mother D1 Electrolyte fluid


D2
lightsoliddiet
D5 Remove sutures

Discharge

13 Complications

Maternal

Immediate Remote

1 PPH 1 Scarrupture futurepregnancy

2 Shock 2 Incisional hernia


3 Anaesthetichazards 3 CPP menstrualdisturbance
hypotension aspin 4 Intestinalobstruct d t adhesions

4 Infection endomyometritis

Stitontis Fetal
SSI
1 Iatrogenicprematurity
5 ParalyticIleus
2 RDS
6
Injurytothebladder 3 Accidentalscalpel
injury
7 woundhematoma

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