Cesarean Section (Lower Section Cesarean Section – LSCS)

In this article, we will discuss Cesarean Section (Lower Section Cesarean Section – LSCS). So, let’s get started.


Cesarean Section (Lower Section Cesarean Section – LSCS)

Cesarean section (C-section) is the delivery of a newborn through a surgical incision in the abdomen and front (anterior) wall of the uterus.

Indications for C-section

Fetal indications

– Abnormal fetal heart rate patterns (non reassuring fetal status).
– Breech presentation of the fetus (bottom down instead of head down).
– Very low birth weight (<1500 g or 3.3 pounds).
– Active genital herpes lesions.
– Idiopathic thrombocytopenia purpura – disease in which there are low platelets in the blood and easy bleeding.
– Major malformations in the fetus making passage through the birth canal difficult or
impossible.

Maternal indications

– Tumour obstructing the birth canal.
– Large genital warts (condyloma).
– Cervical cerclage – Asuture is placed in the cervix to prevent preterm delivery. Cerclage may be permanent or temporary to allow for vaginal delivery.
– Certain vaginal surgeries (vaginal repair can break down)
– Conjoined twins (Siamese twins).
– Prior surgery in which an incision was made in the uterus (myomectomy – removal of fibroid tumour)
– HIV – The American College of Obstetricians and Gynecologists recommends that HIV + mothers should deliver the fetus by C-section at 38 weeks of pregnancy to reduce the chance of
transmitting the virus to the fetus.

Maternal-Fetal indications

– Cephalopelvic disproportion – Either the baby is too large or the pelvis is too small to allow passage.
– Failure of the cervix to dilate or failure of the fetus to pass down the birth canal.
– Placental abruption – When the placenta tears away from the uterus. This is an emergency situation.
– Placenta previa – This is when the placenta implants over all or part of the cervix.

Incision

• Para median/longitudinal
• Pfannenstial/bikini-line/transverse

Complications

• Injury to the bladder or ureters.
• Bowel injuries may also occur. Risk factors are prior abdominal surgery, and pelvic or abdominal infections, both of which may lead to adhesions (scar tissue)
• Uterine atony: A condition in which the uterus does not contract down adequately after delivery and lead to massive haemorrhage. If conservative treatment fails, the surgeon may try to tie off one or both of the arteries to the uterus. A hysterectomy may be required on rare occasions to control the bleeding if other measures fail.
• Wound infection.
• Urinary tract infection.
• Failure of bowel function causing bowel distension.
• Deep venous thrombosis: Blood clots in the veins of the legs or pelvis that may go to the lungs (pulmonary embolus)

Physiotherapy

• Feeding positions/Handling the baby
• Management of long-term post natal problems
• Back care
• Postural correction
• Abs exercise
• Avoid sex for 2–3 months
• Exercises /diet
• Discharge to home in 2-5 days

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