Cesarean section
DEFINTION: A Surgical procedure involving incision of
.the wall of the abdomen and uterus for delivery of fetus
It is one of the safest types of surgeries and one with few
.complications
Indications for Cesarean Birth:
1.Maternal Factors
2.Placenta Factors
Fetal Factors .3
:Maternal factors
1. Active genital herpes or papilloma
2. AIDS or HIV-positive status
3. Cephalopelvic disproportion
4. Cervical cerclage (cervical stitch)
5. Failed induction or failure to progress in labor
6. Obstructive benign or malignant tumor
7. Previous cesarean birth by classic incision
Elective—no indicated risks .8
severe hypertension .9
Placenta Factors:
1. Placenta previa.
2. Premature separation of the placenta.
3. Umbilical cord prolapse.
Fetal factors:
1. Compound conditions such as
macrosomic fetus in a breech lie
2. Extreme low birth weight
3. Fetal distress
4. Major fetal anomalies, such as hydrocephalus
5. Multigestation or conjoined twins
6. Transverse fetal lie
There are two types of cesarean birth:
1.scheduled
2. emergency
1. scheduled, there is time for thorough
preparation for the experience throughout the
antepartal period. Some women even take a
childbirth preparation class specifically for
cesarean birth.
When the women do scheduled cesarean
birth?
transverse presentation
genital herpes
cephalopelvic disproportion
or avoidance of postprocedure stress incontinence,
must be documented before a cesarean
procedure can be performed.
2. emergency cesarean birth, preparation must be
done much more rapidly but with the same
concern for fully informing a woman and her
support person about what circumstances
created the need for a cesarean birth and how
the birth will proceed.
Emergency cesarean births are done for
reasons such as
1. placenta previa,
2. abruptio placentae,
3. fetal distress,
4. or failure to progress in labor.
An emergency cesarean birth carries with it the
risk of any emergency surgery: the woman
may not be a prime candidate for anesthesia
and is psychologically unprepared for the
experience.
In addition, the woman may have a fluid and
electrolyte imbalance and be both physically and
emotionally exhausted from a long labor.
Types of Cesarean Incision:
A classic cesarean incision, the incision is made
vertically through both the abdominal skin and
the uterus. It is made high on the uterus so that
it can be used with a placenta previa, to avoid
cutting the placenta. A disadvantage of this type
of incision is that it leaves a wide skin scar and
runs through the active contractile portion of
the uterus.
Because this type of scar could rupture during
labor, it is likely, if this type of incision is used,
that the woman will not be able to have a
subsequent vaginal birth.
A low segment incision (transverse incisions) is
made horizontally across the abdomen just over
the symphysis pubis and also horizontally across
the uterus just over the cervix.
This is the most common type of cesarean incision
currently used. It is also referred to as a
Pfannenstiel incision , because even a low-cut
bathing suit would cover it.
The major disadvantage of this incision is that it
takes longer to perform, possibly making it
impractical for an emergency cesarean birth.
Because this type of incision is through the
nonactive portion of the uterus (the part that
contracts minimally with labor), it is less
likely to rupture in subsequent labors,
making it possible for the woman to have a
VBAC with a future pregnancy.
It also results in (advantage)
1. less blood loss,
2. is easier to suture,
3. decreases postpartal uterine infections, and
4. less likely to cause postpartum gastrointestinal
complications.
Operative Risks for a Woman
1. Obesity
A woman who is obese is at risk because obesity
interferes with wound healing.
A prolonged healing period increases the risk for
.infection and rupture of the incision (dehiscence)
2. Age Variations:
Age affects surgical risk because it can cause
decreased circulatory and renal function.
Fortunately, most pregnant women fall within the
young adult age group, so they are excellent
candidates for surgery.
A woman older than 40 years of age falls into a
.category of slightly higher risk
3. Altered General Health:
A woman who has a secondary illness (e.g.,
cardiac disease, diabetes mellitus, anemia, kidney
or liver disease) is at greater than usual surgical
risk, depending on the extent of disease.
4. Fluid and Electrolyte Imbalance:
1. A woman who enters surgery with a lower than
normal blood volume will feel the effect of
surgical blood loss more than a woman who has
a normal blood volume.
2. Recent vomiting, diarrhea, or a chronic poor
fluid intake can compound her risk.
5. Fear: Women who are extremely worried need
a very detailed explanation of the procedure before
they can enter surgery without intense fear.
Operative Risk to the Newborn
Cesarean birth places a newborn at a greater risk
than does a vaginal birth.
When a fetus is pushed through the birth canal,
pressure on the chest helps to rid the lungs of lung
fluid.
Therefore, respirations are more likely to be
adequate at birth than if the fetus had not been
subjected to this pressure.
For this reason, more infants born by cesarean
birth develop some degree of respiratory difficulty
for a day or two after birth than those born
vaginally, which is often referred to as transient
.tachypnea of the newborn
Preoperative Diagnostic Procedures
Vital sign determination
Urinalysis
Complete blood count
Coagulation profile (prothrombin time [PT], partial
thromboplastin time [PTT])
Serum electrolytes and pH
Blood typing and cross-matching
Sonogram to determine fetal presentation and
maturity
: Types of anesthesia
Local/regional anesthesia
Most C-sections are performed under local or
regional anesthesia, which is usually a safer option
than general anesthesia. Delivery of the baby
takes around 5 to 10 minutes and the whole
.procedure is usually over within 40 or 50 minutes
Spinal anesthesia
is a common form of anesthesia used for both
urgent and elective procedures. A single dose of
regional anesthetic is injected into the fluid around
the spinal cord using a needle. This numbs the
nerves in the lower body, from the waist down to
the toes, for around two to three hours. The
benefit of spinal anesthesia is that it blocks pain
quickly, with only a small dose of anesthetic being
used. Spinal anesthesia is also referred to as
saddle block anesthesia because it numbs the area
of the body that would come into contact with a
.saddle if a person was on a horse
Epidural anesthesia
Here, a sterile guide needle and a catheter are
inserted into the epidural space, the space around
the spinal nerves present in the lower back. The
catheter is placed at or below waist level and area
where the needle will be inserted is numbed with a
local anesthetic. The needle is then inserted and
removed, while the catheter stays in place, taped
along the centre of the back. The anesthetic is
then administered via the catheter, as required to
numb the body above and below the injection
point. An epidural requires a larger does of
anesthetic than spinal anesthesia and it can take
.longer to work
General anesthesia
is used when your medical history or an
emergency dictates that regional anesthesia is too
.risky or not possible
: Nursing diagnosis
Risk for maternal and fetal injury related to -1
surgical
Risk for infection related to break in skin-2
Knowledge deficient related to inadequate of -3
cesarean delivery
Acute pain related to surgical trauma-4
Powerlessness and anxiety or fear related to -5
lifestyle of helplessness
Risk for deficient fluid volume related to -6
excessive blood loss during surgery
Risk for bleeding related to increasing maternal -7
age
