1. Introduction
2. Explain indication
- breech presentation
-previous scar
-placenta previa major
-macrosomic baby
-unstable lie
-fibroid / cyst obstructing the lower segment
3. Explain on procedure
- we will give admission form to admit to ward one day prior to operation
- ELSCS at 38 weeks
-fasting start at 12MN
-blood taking for FBC and GXM 2 pints pack cells
-also take consent for blood transfusion and hysterectomy in case anything happened
-CBD will be inserted in the morning before operation
-prophylaxis antibiotic will be given
- operation done by epidural/ CSE – anaest will review before operation
-duration 30-45 minutes
- lower abdomen will be cut for 10cm, baby out, placenta out, sutured
4. Explain complication
Early
- anaesthetic complication : nausea, vomiting, headache
-bleeding / PPH
- injury to bladder/ colon
-infection
Late
-decrease family size, limit to 3 lscs only
- adhesion
-next pregnancy LSCS
5. Postpartum
- 3 days monitoring in the ward for any bleeding
-give prophylaxis s/c heparin 5000iu thromboprophylaxis
-Wound inspection at day2
-monitor urine output, CBD will be romeved if patient can ambulate well
6. Advice patient on contraception
- need to have good spacing 2 years
- use contraceptive device that has good pearl index
-ensure patient compliance
-TCA 6 weeks at family planning clinic
7. Ask for any enquiries
sources: teaching with dr nasir
hanisah A115275
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