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CESAREAN SECTION (CS)

In Partial Fulfillment of the Requirement for the Course
NCM 109: Care of Mother, Child at Risk
with Problems (Acute & Chronic)

Submitted by:
Cruz, Railey Igie C.
Dawang, Aleena Marie G.
Del Rosario, Nina Alessandra G.
Jacinto, Hanna Ryza DR.
Leonardo, Franz Miguel L.
Magtuto, Justin M.
Maramag, Lalaine G.
Medrano, Mizharie M.
Natividad, Jerome M.
BSN 2F

Submitted to:
Adelfa C. Garcia MAN, RN
Clinical Instructor

APRIL 2025
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A.​ INTRODUCTION OF THE DISEASE

CESAREAN BIRTH
A surgical procedure in which a baby is delivered through incisions made in the mother’s
abdomen and uterus. This is preferred over vaginal delivery if: Vaginal delivery could
compromise the state of fetus, mother, or both. Can be performed as a maternal request. There is
an occurrence wherein the fetus, the mother, or both are at risk of experiencing further
complications.

TYPES OF CESAREAN BIRTH

Lower Segment Cesarean Section
The most common type, where a horizontal incision is made in the lower part of the uterus. This
method causes less blood loss and has a lower risk of complications, allowing for possible future
vaginal births (VBAC).

Classical Cesarean Section

A vertical incision is made in the upper (contractile) part of the uterus. It is rarely used today
except in emergencies (e.g., preterm births, placenta previa, transverse fetal lie) due to the higher
risk of rupture in future pregnancies.

Bikini Cesarean Section

a common type of C-section where the abdominal incision is made horizontally, just above the
pubic hairline, resulting in a less noticeable scar and potentially quicker healing compared to a
vertical incision

TYPES OF SURGICAL REPAIR

AFTER THE BABY IS DELIVERED, THE UTERUS AND ABDOMINAL LAYERS ARE
REPAIRED USING DIFFERENT TECHNIQUES:

Single Closure
The uterine incision is closed with one layer of sutures. Faster but may have a higher risk of
uterine rupture in future pregnancies.

Double Layer Closure

Two layers of sutures are used to close the uterus, providing extra strength and reducing rupture
risk

Staple VS Skin Suture

The outer skin incision can be closed using either staples (faster healing but slightly higher
infection risk) or sutures (slower but better cosmetic results).

INDICATIONS:
Maternal Indication
●​ Cephalopelvic disproportion (CPD) – baby’s head is too large for the mother’s pelvis.
●​ Previous C-section with a high risk of rupture.
●​ Maternal medical conditions (e.g., severe pre-eclampsia, heart disease).
●​ Active genital herpes infection (risk of neonatal transmission).
●​ Uterine rupture or abnormalities (e.g., fibroids, uterine malformations).
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Fetal indication
●​ Fetal distress (e.g., abnormal fetal heart rate, low oxygen supply).
●​ Malpresentations (e.g., breech, transverse lie)
●​ Cord prolapse (umbilical cord slips through the cervix before the baby)
●​ Multiple pregnancies (especially with complications like twin-twin transfusion
syndrome).

Placental indication

●​ Placenta previa (placenta covers the cervix).

●​ Placental abruption (placenta detaches too early, causing bleeding)

Risk factors for C-section

●​ Previous C-section or uterine surgery.

●​ Maternal obesity.
●​ Diabetes or hypertension during pregnancy.
●​ Large baby (macrosomia).
●​ Prolonged labor (failure to progress).
●​ Multiple gestations (twins, triplets, etc.).
●​ Induced labor with unsuccessful results.
●​ Fetal abnormalities (e.g., hydrocephalus, congenital anomalies).

B.​ NORMAL ANATOMY

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How is Caesarean section done?

1.​ Preparation of client

A.​ Pre-op lab tests:
-​ CBC
-​ Blood typing and screening
B.​ Continuous fetal monitoring
C.​ Prophylactic antibiotics
D.​ Wedge under one hip:
-​ For reduced compression of Aorta and Inferior vena cava
-​ To promote placental blood flow
E.​ Urinary catheter
F.​ Anesthesia
-​ Epidural
-​ Spinal-epidural
-​ General (if emergency procedure)
G.​ Sterile abdominal skin preparation (using povidone iodine)

2. Incision in the abdominal wall

A.​ Vertical incision:
-​ More suitable for clients with abdominal obesity
-​ Faster to cut
-​ Better visualization
-​ Incision can be extended if needed
B.​ Horizontal incision:
-​ Smaller scar
-​ Lower chance of dehiscence or hernia

3. Bladder is separated from the uterus.

4. Second incision:
-​ Amniotic sac is ruptured
-​ Suctioning of Amniotic fluid (inspect the color, odor, and quantity)

5. Newborn care
-​ Infant’s nose and mouth are suctioned.
-​ Umbilical cord clamped and cut.
-​ Baby handed to the neonatal team

6. Placenta is extracted
A.​ Antibiotics administered
B.​ Oxytocin:
-​ For uterus to contract
-​ To control bleeding
C.​ Uterine and abdominal cavities are inspected and rinsed with saline.
D.​ Incisions are stitched and stapled closed.

7. Fundus is massaged

8. Abdominal dressing and pad applied to the perineum.

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Maternal complications:
●​ Infection
●​ Wound dehiscence
●​ Hemorrhage
●​ Venous thromboembolism
●​ Drug reactions
●​ Aspiration pneumonia
●​ Injury to bowel or bladder

Fetal complications:
●​ Unintended preterm delivery
●​ Injuries (lacerations, fractures, and bruising)
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C.​ PATHOPHYSIOLOGY
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D.​ NURSING CARE PLAN

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E.​ DRUG STUDY AND MANAGEMENT

Drug: Preoperative Antibiotic Prophylaxis (Cefazolin)
Classification: First generation Cephalosporin antibiotic
Indication: Prophylaxis against surgical site infections in cesarean delivery
Dosage and Route: 2-3 grams IV administered 30-69 minutes prior to skin incision
Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding
proteins, leading to cell lysis. Broad-spectrum against many Gram-positive and some
Gram-negative bacteria
Contraindication: Allergy to cephalosporin antibiotics, severe hypersensitivity to penicillin
Side Effects: Nausea, vomiting, diarrhea, rash, allergic reactions, C. difficile associated diarrhea,
thrombophlebitis at injection site

Before
●​ Obtain a detailed medical history, including allergies, previous surgeries, and existing
medical conditions.
●​ Confirm gestational age and fetal well-being.
●​ Monitor vital signs (temperature, pulse, respiration, blood pressure).
●​ Perform a physical assessment, including abdominal examination.
●​ Review laboratory tests (CBC, CRP, urine analysis).
●​ Explain the purpose of cefazolin and its role in preventing infection.
●​ Discuss potential side effects (rash, itching, diarrhea).
●​ Emphasize the importance of monitoring for any signs of infection or adverse reactions.
●​ Record allergies and relevant medical history.
●​ Document time and route of administration.
●​ Note pertinent observations or assessments.

During
●​ Administer cefazolin intravenously as prescribed.
●​ Monitor for allergic reactions or adverse effects.
●​ Ensure proper IV site care.
●​ Continuously check vital signs, especially temperature.
●​ Monitor fetal heart rate and movement.
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●​ Observe changes in vaginal discharge (color, odor, amount).

●​ Assess for any signs of uterine activity or bleeding.
●​ Record time of administration, dosage, and any observed reactions.
●​ Document changes in vital signs, fetal assessment, or vaginal discharge

After
●​ Monitor vital signs, fetal assessment, and vaginal discharge.
●​ Assess for signs of infection (fever, chills, abdominal pain, redness, swelling at incision
site).
●​ Observe adverse reactions to the medication.
●​ Reinforce the importance of reporting any condition changes or symptoms.
●​ Provide information on the duration of antibiotic therapy and follow-up care.
●​ Record post-administration observations and any adverse reactions.
●​ Document the patient’s response to treatment and any condition changes.
●​ Cefazolin administration may be affected by the type of anesthesia used.
●​ Monitor for potential complications like wound infection, bleeding, and blood clots.
●​ Provide clear instructions on wound care, pain management, and signs of infection

Drug: Oxytocin
Classification: Uterotonic
Indication: Uterine contraction for hemorrhage prevention
Dosage and Route: 10-40 units IV infusion, routinely administered during cesarean delivery
Mechanism of Action: Stimulates uterine smooth muscle contraction
Contraindication: Hypersensitivity, fetal distress, hypertonic uterine contractions
Side Effects: Hypotension, tachycardia, nausea, vomiting

Before
●​ Obtain a detailed medical history, including allergies, previous pregnancies, and existing
medical conditions.
●​ Confirm gestational age and fetal well-being.
●​ Monitor vital signs (temperature, pulse, respiration, blood pressure).
●​ Perform a physical assessment, including abdominal examination.
●​ Review laboratory tests (CBC, CRP, urine analysis).
●​ Explain the purpose of oxytocin and its role in preventing PPH.
●​ Discuss potential side effects (nausea, vomiting, headache, uterine hyperstimulation).
●​ Emphasize the importance of monitoring for any signs of infection or adverse reactions.
●​ Record allergies and relevant medical history.
●​ Document time and route of administration.
●​ Note pertinent observations or assessments

During
●​ Administer oxytocin intravenously as prescribed, usually as a bolus followed by a
continuous infusion.
●​ Monitor for allergic reactions or adverse effects.
●​ Ensure proper IV site care.
●​ Continuously check vital signs, especially blood pressure and pulse.
●​ Monitor fetal heart rate and movement.
●​ Observe changes in vaginal discharge (color, odor, amount).
●​ Assess for any signs of uterine activity or bleeding.
●​ Monitor for signs of uterine hyperstimulation (excessive contractions, fetal distress).
●​ Record time of administration, dosage, and any observed reactions.
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●​ Document changes in vital signs, fetal assessment, or vaginal discharge

After
●​ Monitor vital signs, fetal assessment, and vaginal discharge.
●​ Assess for signs of infection (fever, chills, abdominal pain, redness, swelling at incision
site).
●​ Observe adverse reactions to the medication.
●​ Continue monitoring for uterine activity and bleeding.
●​ Reinforce the importance of reporting any condition changes or symptoms.
●​ Provide information on the duration of oxytocin therapy and follow-up care.
●​ Record post-administration observations and any adverse reactions.
●​ Document the patient’s response to treatment and any condition changes.
●​ Oxytocin dosage is carefully titrat

Drug: Acetaminophen
Classification: Analgesics
Indication: Postoperative pain management
Dosage and Route: 650-1000 mg PO PRN
Mechanism of Action: Central inhibition of prostaglandin synthesis
Contraindication: Severe hepatic impairment
Side Effects: Liver damage

Before
●​ Obtain a detailed medical history, including allergies, previous surgeries, and existing
medical conditions.
●​ Confirm gestational age and fetal well-being.
●​ Monitor vital signs (temperature, pulse, respiration, blood pressure).
●​ Perform a physical assessment, including abdominal examination.
●​ Review laboratory tests (CBC, CRP, urine analysis).
●​ Explain the purpose of acetaminophen and its role in pain management.
●​ Discuss potential side effects (nausea, vomiting, rash).
●​ Emphasize the importance of monitoring for any signs of infection or adverse reactions.
●​ Record allergies and relevant medical history.
●​ Document time and route of administration.
●​ Note pertinent observations or assessments

During
●​ Administer acetaminophen intravenously as prescribed, usually as a bolus followed by a
continuous infusion or as a single dose.
●​ Monitor for allergic reactions or adverse effects.
●​ Ensure proper IV site care.
●​ Continuously check vital signs, especially temperature.
●​ Monitor fetal heart rate and movement.
●​ Observe changes in vaginal discharge (color, odor, amount).
●​ Assess for any signs of uterine activity or bleeding.
●​ Monitor for signs of pain relief and effectiveness of the medication.
●​ Record time of administration, dosage, and any observed reactions.
●​ Document changes in vital signs, fetal assessment, or vaginal discharge

After
●​ Monitor vital signs, fetal assessment, and vaginal discharge.
​ ​ ​

●​ Assess for signs of infection (fever, chills, abdominal pain, redness, swelling at incision
site).
●​ Observe adverse reactions to the medication.
●​ Continue monitoring for pain relief and effectiveness of the medication.
●​ Reinforce the importance of reporting any condition changes or symptoms.
●​ Provide information on the duration of acetaminophen therapy and follow-up care.
●​ Record post-administration observations and any adverse reactions.
●​ Document the patient’s response to treatment and any condition changes.
●​ Acetaminophen dosage is carefully titrated based on the individual patient and the desired
effect.
●​ Close monitoring of pain levels and effectiveness of the medication is crucial during
acetaminophen administration.
●​ Provide clear instructions on pain management, signs of infection, bleeding, and potential
side effects

F.​ LABORATORY TEST

Complete Blood Count
●​ Determines blood type and compatibility for potential blood transfusion in case of
excessive blood loss.
Blood Type and Screen CrossMatch
●​ Determines blood type and compatibility for potential blood transfusion in case of
excessive blood loss.
Screening Test for Human Immunodeficiency Virus, Hepatitis B, Syphilis
●​ Evaluates blood clotting ability to assess risk of bleeding during and after surgery.
Coagulation Studies (Prothrombin and Activated Partial Thromboplastin Times,
Fibrinogen Level)
●​ Evaluates blood clotting ability to assess risk of bleeding during and after surgery.
Imaging Studies
●​ Document fetal position and estimated fetal weight, and to identify any potential
anatomical abnormalities.

G.​ SURGICAL PROCEDURE

Laparotomy Incision
Initial incision made through the abdominal wall to access the uterus.
●​ Midline infraumbilical incisions run vertically from below the navel, offering quick
access and good visualization, particularly in emergencies.
●​ Transverse incisions, such as Pfannenstiel (“bikini cut” or Joel-Cohen, are made
horizontally just above the pubic bone, generally resulting in less visible scarring and
potentially less postoperative pain.

Hysterectomy Incision
Incision made into the uterus itself to deliver the baby.
●​ Transverse (Monroe-Kerr) hysterotomy, a low transverse incision, is the most common
type, performed in the lower uterine segment, and is associated with less risk of future
uterine rupture.
●​ Vertical hysterectomies (like Kronig or DeLee)involve a vertical incision in the uterus,
and are generally reserved for situations requiring rapid delivery, or in cases of certain
complications, such as a very premature baby.
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Incision made into the uterus itself to deliver the baby.

●​ Transverse (Monroe-Kerr) hysterotomy, a low transverse incision, is the most common
type, performed in the lower uterine segment, and is associated with less risk of future
uterine rupture.
●​ Vertical hysterectomies (like Kronig or DeLee) involve a vertical incision in the uterus,
and are generally reserved for situations requiring rapid delivery, or in cases of certain
complications, such as a very premature baby.