Cesarean Section Indications Nursing Care for LSCS Operation

Definition of Cesarean Section ;

It is a surgical procedure usually after the end of the 28th week of gestation made an incision

through the abdominal wall and uterus wall to deliver the fetus through the abdominal wall. It is on Operative procedure

Routine Cesarean section delivery is not recommended

The pregnant mother who has complications in the Progress of Labour or Pregnancy is not permitted

to give birth from Normal Labour or Vaginal Delivery,

The delivery of Viable fetus through Incision in abdominal wall and uterus

Classification of LSCS 

category

1- Immediate threat to the life of woman or Fetus,

2- Maternal or fetal compromise but not immediately life-threatening,

 3 – Needing early delivery but no maternal or fetal compromise,

 4 – At a time to suit the woman and cesarean section team

Robson Classification for Cesarean section

Group-1
Nulliparous with single cephalic pregnancy, >_37 weeks gestation in spontaneous labor

Group-2
Nulliparous with single cephalic pregnancy,>_37 weeks gestation who either had labor indicator were discovered by Cesarean section before labor,

Group-3
Multifarious without a previous uterine scar, with single cephalic pregnancy, >_37 weeks gestation in spontaneous labor,

Group-4
Multiparous without a previous uterine scar with single cephalic,

pregnancy, >_37
weeks gestation who either had labor induced or were delivered by cesarean section before labor,

Group-5
All Multiparous with at least one previous uterine scar, with single cephalic pregnancy, >_37 weeks gestation,

Group-6
All Nulliparous women with a single breach pregnancy,

Group -7
All Multiparous women with a single breach pregnancy including women with previous uterine scars,

Group-8
All women with Multiple pregnancies, including women with previous uterine scars,

Group-9
All women with single pregnancy with a transverse or oblige lie, including women with previous uterine scars,

Group-10
All women with single cephalic pregnancy < 37 weeks gestation, including women with previous scars,

Indications for cesarean section

1. Cephalo – pelvic disproportion(CPD),

2. Abnormal lie,

3. Abnormal presentation: breech or transverse, oblique,

4. Abruptio placenta,

5. Adherent placenta,

6. Placenta praevia,

7. cord prolapse/presentation,

8. Failure induction,

9.Failure to progress,

10. HELLP syndrome,

11. Higher-order multiples(triplets or more),

12. HIV Positive,

13. IUGR, Doppler compromise,

14. Maternal request,

15.Others(mention),

16.Pelvis tumors as a contraindication to delivery,

17. Bad obstetric history,

18. presumed fetal compromise,

-Abnormal CTG,

-Meconium stained liquor,

-Abnormal CTG + Meconium stained liquor,

19. Previous preterm cesarean section/hysterectomy/myomectomy,

upper segment cesarean section.

20. Previous uterine surgery (other than CS),

21. Rh ISO immunization,

22. Suspected scar dehiscence,

23. Twin pregnancies (Non-cephalic),

24. Two previous Lscs or more,

25. Vaginal lesion/infection as contraindication vaginal delivery

Preoperative Assessment for C- Section

History collection about past and present Medical-Surgical, obstetrical history,

Check Obstrectrician orders, complete documentation process i.e, a Consent form signed

Assess knowledge of mother about C Section procedures,

Monitor Maternal and Fetal Vital Signs,

Identify Drug allergies,

Labour Status

Uterine Contractions, Frequency, Duration, Intensity,

Vaginal Discharge – Bloody Show, Amniotic fluid Clor, and odor,

Vaginal Changes Dilatation, effessment,

Descent of fetus – presentation, Station, Position,

Abdominal Examination

Assess bowel sounds,
Assess fundal height,

Preoperative Diagnostic Procedures for C Section

USG Abdomen,

Haemoglobin Percentage,

Blood Group and Type,

WBC count,

Deferential Count,

Platelets,

RBS,

Serum Creatinine,

Blood Urea,

Serum Electrolytes,

HIV,

Hepatitis B,

CT BT,

Urine Sugar,\Urine Albumin,

Preoperative Measures for Cesarian Section

Prepare mother for C Section in the operating room,

Check for Identification data,

ID bracelet correct,

Check for proper documentation and doctors orders,

Diagnostic procedures

Check Status of NBM before surgery,

Skin Preparation,
Remove all jewelry

Dress in operating room gown,
Insert Intra Cath for IV infusion line,

Nursing responsibility in C Section

Check the mother’s vitals and fetal heart rate,

Support and assist in maintaining the positioning of the patient during anesthesia

Support mother until time baby birth and complete procedure,

Assist neonatal care at birth, during resuscitation, and Newborn Examination,

APGAR Score,

Ensure name ID bracelets are checked, mother and Newborn baby

Establish bonding mother and child interaction and skin to skin contact,

Weight the baby,

Keep baby in a warm towel,

Complete documentation of the procedure,

Preparation of Articles for LSCS

Obstrectical General Tray,

Towel Pack,

Surgical and Medical supplies,

Intra Operative Measures for Cesarian Section

LSCS Surgery Steps

Peri-Operative Preparation,

Incision

Delivery of Head and Trunk,

Placenta and Membranes,

Suturing,

Nursing Diagnosis

Anxiety – Anxiety related to cesarian delivery,
Pain-related to surgical procedure,
Risk for Infection – related to traumatized tissue,
Deficient knowledge- Lack of exposure to C Section

Post Operative care for C Section

The mother and child condition is assessed in the post-operative ward or
OT recovery room

Asses for the level of consciousness,
Record vital signs Blood Pressure, Pulse Rate, Respiration, Temperature,
SPO2 Level every 15 mins up to two hours,
Check for the Doctors orders,
for the previous analgesia administered,
Assess Level of pain and a prescription for further,
Check for the potency of a urinary catheter, color and amount of urine,
Assess for wound site for ooze,
Discharge amount of lochia,

Should be maintained Optimum ventilation and hemodynamic status

Encourage deep breathing and coughing exercises,
Leg exercises and Begin ambulation within 6-12

Provide skin to skin contact mother and baby to preventing hypothermia,
and developing bonding between baby and mother,
Encourage and assist in breastfeeding

after surgery, if prescribed for oral and diet,
introduce sips of water to mother,
Introduce liquid and diet as prescribed,

Give Health education about personal hygiene and perineal care,

Teach mother about newborn care and importance of immunization,

Counsel the couples for family planning methods,

Complications during Delivery or Cesarian operation

Intrapartum for Vaginal delivery Complications to the Mother
1. Amniotic fluid embolism,
2. Hematoma,
3. Perineal laceration,
4. Placental abnormalities (Abruptio, Accreta, Retainers placenta),
5. Preeclampsia,
6. Prolonged labor,
7. Obstructed labor,
8. Uterus Abnormalities (Ruptured uterus, Uterine atony, Inversion, or uterus),
9. Unplanned hysterectomy,
Complications to the baby,
1. Birth Asphyxia,
2. Birth injury,
3. Cord Prolapse,
4. IUFD (Intra Uterine Fetal death),
5. Meconium aspiration syndrome,
6. Shoulder Dystocia,

Intra-operative Complications to the Mother

1. Blood clots,
2. Disruption of uterine arteries,
3. Excessive blood loss(Hemorrhage),
4. Hysterectomy,
5. Incidental surgical injuries-Lacerations, abrasions, and scarring,
6. Placenta accreta,
7. Pelvic organ injuries: Uterine, Urethral, bladder, and bowel injuries,
8. Uterine atony and hypotonia,

Complications to the baby

1. Birth Asphyxia,
2. Erb’s Palsy,
3. Incidental surgical Injuries-Lacerations, abrasions, and scarring,
4. Intracranial Hemorrhage,

Complications of Cesarean Section

Maternal

Hemorrhage.
Bladder Injury,
Urethral injury,
Castro Intestinal Injury,
Infection,
Wound Complications,

DVT Deep Vien thrombosis,

chronic Pelvic Pain or Backache,

Incisional Hernia,

Intestinal Obstruction due to adhesions and bonds,

C Section Complication After at Future pregnancy,

Scar dehiscence,
Scar Rupture,