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Caesarean Section


Surgical delivery by incision into the uterus.

  • When safer for mother or foetus than vaginal delivery

  • Rate 15-25%

Types

  • classical

    • longitudinal incision in anterior wall of uterus, ascending to fundus

    • reasons

  • lower segment

    • transverse or longitudinal incision into lower segment (obviously!)

    • heals quicker

    • less risk future rupture

    • less risk post-op complications

Indications

  • foetal distress in first stage

  • delay in first stage >10 hours, failed forceps or ventouse

  • two previous LSCS

  • major grade placenta praevia

  • abruption

  • cord prolapse

Indications for classical Caesarean section

  • fibroids in lower segment

  • transverse lie

  • prematurity

Subsequent pregnancies

  • vaginal birth in 75%

  • after 2 caesarean sections risk of rupture too great to allow vaginal delivery

  • after 1 LSCS attempted vaginal delivery is 'trial of scar'

Risks

  • general surgical

    • haemorrhage

    • infection

 

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