WRITE UPS - CESAREAN SECTION - Cesarean Section Current Concepts


Many aspects of cesarean section (CS) have changed over a period of time. Indications of cesarean section currently include Intra Uterine Growth Retardation and oligohydramnios as current additions. Technological additions like Cardio Tocography (CTG) have enabled obstetricians to pick up fetal distress early and invite additional indications for C.S.

It is now recommended that pre-load should always be given to a subject to be taken for CS. Currently epidural anesthesia and spinal anesthesia are preformed over GA. Pre-load with lactated ringer solution prevents a fall of BP in regional anesthesia.

Vertical midline incisions are now hardly used. Transverse incisions are most preferred. For the delivery of the head when deeply impacted, Patwardhan’s method is found to be safe and successfully prevents extensions.

The habit of suturing the uterus in two layers has been found to be useless. Now a day, uteri on CS are sutured in a single layer. Synthetic absorbable materials (like Vicryl) are preferred due to many advantages.  Suturing of peritoneum both visceral and parietal are found to be unnecessary especially when the abdomen is opened by a transverse incision. Infact leaving the peritoneum unsutured prevents subsequent adhesions including that of the bladder to the uterus. Skin stitches are now preferred as subcuticular or by stapling.

Antibiotics preferred now are in prophylactic doses rather than in the age-old curative regimes.  A dose of appropriate antibiotic given during surgery and the other dose after 6 hrs is all that is required for these cases.

Many such current trends have made cesarean sections a lively proposition and no more the same old drab surgery.



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