Caesarean Section Literature Review

CHAPTER TWO

2.0 LITERATURE REVIEW

2.1HISTORY OF CAESAREAN SECTION

Several debates in different circles have arisen to actually pin point the origin of the name Caesarean section though the origin has been distorted over time. One of the three most popular theories linked to the origin of Caesarean section is that Julius Caesar was delivered through Caesarean section. However if this is true, it is surprising that his mother aurelia was still alive when he invaded Britain. For her to have survived would be unlikely because knowledge of human anatomy at the time was minimal and also because the procedure was performed only when the mother was dead or dying as an attempt to save the child for a state wishing to increase its population.(Sewell

2002). The weeks of gestation stated in the definition is the period of viability which varies from country to country.In the United States of America, is 22weeks ,in the United Kingdom,is 24weeks.But for the purposes of our environment; Ghana, its 28weeks.WHO defines the period of viability as 22completed weeks from the date of onset of the LMP.

2.3VARIOUS TYPES OF CAESAREAN SECTION

The first CS performed on a patient is known as primary CS; subsequent Caesarean deliveries are referred to as secondary, tertiary and so on or simply a repeat CS.(Medscape 2015)

Several types of Caesarean section exists. Based on the incision made through the uterus, it can be classified into several types but mainly classical caesarean section and low uterine segment Caesarean section

• Classical Caesarean section:This term is used when a midline longitudinal incision is made on the uterus to allow a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.

• Lower uterine segment section: This is the procedure mostly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair.

Figure 1 SHOWING THE TYPES OF CAESAREAN

It is one performed either after the onset of labor which later results in a complication that constitutes an urgent indication or when normal pregnancy after foetal viability is complicated such that the life of the mother and/or the foetus is at risk.

(NHS 2014)… http://www.nhs.uk/conditions/Caesarean-section/pages/introduction.aspx

2.4INDICATIONS

Several reasons are behind the indications for Caesarean section and it is not possible to completely list all appropriate indications for Caesarean delivery [Cunningham FG et al 2010, Dickson JE et al 2006].

Some grouped them into absolute indications and relative indications, others group them into maternal factors, foetal factors and maternal-foetal factors, some also group the indications under Emergency Caesarean section and Elective Caesarean section. Despite all these groupings most of the causes are the same just that different headings have been given to them. However in this study, the focus would be on the Maternal, foetal causes and maternal-fetal factors.

Maternal factors: These are factors related to the mother.This include

• Severe pre-eclampsia with unfavourable cervix for vaginal delivery,

• Previous classical Caesarean section

• Previous extensive uterine surgery(myomectomy) in which the uterine cavity has been