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2. ELECTIVE CAESAREAN SECTION
HISTORY:
•JULIUS CAESAR,THE ROMAN EMPEROR WAS DELIVERED BY SECTION.
•THE EARLIEST REPORT --- IN SUMER IN 2000 BC – WAS DONE ON SLAVES.
•IN 1581,FRANCOIS ROUSSET DESCRIBED 14 PROCEDURES.
•QUEEN VICTORIA DELIVERED LEOPARD AND BEATRICE (1857) BY C.S.
USING CHLOROFORM.
•MAX SANGER, IN 1882 SUTURED THE UTERUS IN TWO LAYERS USING
SILVER WIRE AND SILK; REDUCED H-GE, BUT REMAINED INFECTIVE.
•FRANK AND LATZKO, IN 1909 DESCRIBED EXTRAPERITONEAL APPROACH.
•VERTICAL MEDIAN – BY KRONIG,BECK AND DE LEE IN 1912,1919,1922.
•MUNRO KERR (1926) – DESCRIBED LSCS.
•ALEXANDER FLEMING DISCOVERED PENICILLIN IN 1928.PURIFIED IN 1940.
INCIDENCE:
RANGES BETWEEN 5 TO 20%. MORE THAN 15% IS NOT JUSTIFIED.
THE RISE FROM 1.9% IN 1950s TO 16% NOW [ THE C.S. EPIDEMIC ];
DUE TO : 1) REDUCED PARITY IN 50% OF CASES.
2) ADVANCED MATERNAL AGE,
3) BREECH PRESENTEIONS IN > 80%,
4) MALPRACTICE LITIGATIONS.
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3. INDICATIONS:
MATERNAL;(1) PLACENTA PRAEVIA (4)PREVIOUS VAG.SURGERY
(2) OBSTRUCT. G.T. LESIONS (5)PELVIC MALFORMATIONS
(3) CARCINOMA CERVIX (6)MEDICAL DISORDERS
FETAL ; (1) ABNOR. PRESENTATIONS (4) INFECTIONS [HERPES,HIV]
(2) FETAL DISTRESS (5) IUGR, PRETERM.
(3) FETAL ANOMALIES
FETOMATERNAL :
(1) SEVERE PIH
(2) CONJOINED TWINS
(3) CLASSICAL CAESAREAN SECTION
(4) PLACENTA PRAEVIA.
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4. TIMING OF ELECTIVE CAES.SECTION:
• FETAL MATURITY IS IMPORTANT TO DETERMINE
• THE OPERATION TO BE DONE CLOSE TO 37W. IN CERTAIN DATES.
• IN UNCERTAIN DATES THE FOLLOWING GUIDELINES MAY HELP :
(1) UTERINE SIZE BEFORE 16/52
(2) CRL --- IN FIRST TRIMESTER
(3) USG --- GESTATIONAL AGE PRIOR TO 24/52
(4) BPD --- 9.2cm [ NONDIABETIC]. FL --- 7.3cm ARE RELIABLE.
(5) AMNIOCENTESIS – L/S > 2 & +VE PHOSPHATIDYLGLYCEROL.
(6) WAITING FOR PATIENT TO SET INTO LABOUR.
VBAC (VAGINAL BIRTH AFTER C.S.):
• CRAGIN”1916”STATED – ‘ONCE A C.S. ALWAYS A C. S.’
• NOW – ANTICIPATED SUCCESS IS 60—80%
• POINTS TO BE ANSWERED;
(1) RISK OF UTERINE RUPTURE
(2) VBAC AFTER UNKNOWN SCARS
(3) ROLE OF UTERINE EXPLORATION AFTER VAGINAL DELIVERY.
(4) USE OF OXYTOCIN IN VBAC
(5) VAGINAL TRIAL AFTER MORE THAN ONE C.S.
(6) MULTIPLE PGCIES AFTER C.S.,SHOULD VBAC BE ALLOWED?.www.doctor.sd