Caesarean Section: Operative Procedure And Complication
The operative procedure
The operation most commonly carried out is a lower segment caesarean section (LSCS). A pfannensteil or bikini line incision is usually performed. The lower segment incision is in the less muscular and active part of uterus and heals better. The main reason for preferring the LSCS is the reduced incidence of dehiscence of uterine scar during subsequent pregnancies.
The abdomen is opened and the loose fold of peritoneum (a covering of uterus and bladder) over the anterior aspect of the lower segment of uterus incised. The operator continues to incise this further, to visualise the fundus of the bladder, which is then pushed down and away from the surgeon.
The uterus is then incised transversely, the foetal head is directed outside by the surgeon while an assistant applies fundal pressure. When both the baby and placenta have been delivered, the uterus is sutured and abdomen is closed.
Complications
Caesarean section being a operative procedure is not without its complication. There are three major complications of caesarean section:
- Anaesthetic complications
- Infection
- Thromboembolic disease
Anaesthetic complications pertain to use of anaesthesia and many present as drug allergy, prolonged sedation, aspiration pneumonia and back pain after spinal or epidural anaesthesia.
Infection is one of the major complications of caesarean section. Some series of research have reported an incidence rate of over 34% following caesarean section. It commonly presents as unexplained fever, poor wound healing, pain abdomen and deep seated pelvic pain due to an abscess or pus discharge from the operative wound. Increasing use of antibiotic prophylaxis has reduced the rates of infection after caesarean section. However the most effective way to lower rates of infection following caesarean section is to reduce unnecessary caesarean section.Urinary tract infection is the most consistent infectious episode after caesarean section. One in 10 women will suffer from UTI after caesarean section.
Thromboembolic(clots forming with in blood vessels) disorders remain the leading cause of maternal death, accounting for nearly 35% of all deaths due to caesarean section. Pregnancy carries an increased risk of clots and all women on bed rest and all women undergoing caesarean section should be assessed for deep vein thrombosis prophylaxis.