Aijem Ryan Mejia
Cesarean Birth
Introduction:
Cesarean Birth or birth accomplished through an abdominal incision into the uterus, is one of the oldest
types of surgical procedures known. It is a procedure always slightly more hazardous than vaginal birth.
However when compared with other surgical procedures, it is one of the safest types of surgeries and more
with few complication.
The word cesarean is derived from the Latin caedore, which means to cut. Hypothesize to be
named after the manner of birth of Julius Caesar in 100 BC. Originally used to deliver the baby of a mother
who had died in ancient Egypt, Asia AND Europe. First caesarean section on a live woman was that on the
wife of Jacob Nufer in the 16th century. Earliest report of a child that survive C/S was the birth of Gorgias of
Sicily in 508 BC. The procedure was associated then with high mortality due to sepsis ( lack of antibiotics)
and there was no anaesthesia. Great improvement and survival from the 19th century especially with the
advent of the lower segment C/S BY Munro – Kerr.
Indication for Cesarean Section:
A. MATERNAL INDICATIONS
➢ Severe pre- eclampsia with unfavourable cervix for vaginal delivery. (absolute)
➢ Previous classical caesarean delivery. (absolute) .
➢ Previous extensive uterine surgery with entry into the uterine cavity eg myomectomy.
➢ Obstructive pelvic tumours eg friboids, ovarian cysts.
➢ Previous 30 perineal tears.
➢ Previous successful V V F repair ( absolute).
➢ Vulva herpes simplex.
B. FETAL INDICATIONS FOR C/S.
➢ Fetal distres.
➢ Abnormal presentations – breech, brow (absolute), persistent occipito – posterior in labour, face with
mento – posterior.
➢ Abnormal lies – transverse, oblique,
➢ Multiple gestations – triplets and higher order gestations.
➢ Fetal macrosomia – weight greater than 4500g.
➢ Footling breech,
➢ . Very low birth weight – ( less than 1500g).
➢ Fetal abnormality –hydrocephalus, conjoint twins, spina bafida.
A. MATERNAL – FETAL INDICATIONS FOR C/S.
➢ Cephalopelvic disproportion.
➢ Dystocia –arrest of cervical dilatation or failure of descent of presenting part.
➢ Major degree placenta praevia.
➢ Placental abruption with a live fetus.
➢ Absolute pelvic disproportion.
Types of CS:
1. Low Segment / Low-Transverse / Low-Cervical – Incision is made transversely on the lower segment of
the uterus. Also known as bikini incision.
Advantages:
➢ Involves less blood loss
➢ Less possibility of rupture of CS scar during subsequent pregnancy
➢ Incision is easier to repair
➢ Less incidence of postoperative complications: infection, adhesion
➢ Less possibility of bowel to the incisional line, Intestinal obstruction
Disadvantages:
➢ Difficult and longer to perform than the classical type
➢ Not recommended with anterior placenta previa
➢ Possibility of incision to extend to the uterine vessels laterally
Classical Type / Sanger – A vertical incision is made directly into the walls of corpus, the body of uterine
which is the most contractile portion.
Indication:
➢ Preterm delivery with poorly formed lower segment.
➢ Placenta praevia with large vessels in lower segment.
➢ Premature rupture of membranes, poor lower segment and transverse lie.
➢ Transverse lie with back inferior.
➢ Large cervical fibroid.
➢ Postmortem C/S.
Advantages:
➢ Easiest and quickest incision to perform
➢ Rapid extraction of fetus can be done
Disadvantages:
➢ Involves more blood loss because incision is made on the thick vascular portion of the uterine
➢ Higher incidence of postoperative complications
➢ Rupture of CS scar on subsequent pregnancy and labor is more likely
➢ Involves more healing discomfort and a wider CS scar
3. Extra peritoneal Cesarean Section – Incision is made around the bladder and into the lower uterine
segment without entering the peritoneal cavity.
Advantages:
➢ Useful after prolonged labor
➢ Operation recommended in the presence of amnionitis because spilling of amniotic fluid into the peritoneal
cavity is avoided
Disadvantages:
➢ Operation is difficult to perform
➢ Possibility of uterine bleeding and postoperative infection is high
Types of Abdominal Incision:
1. Infraumbilical Vertical Incision – Quickest incision to make which involves performing a 2cm vertical
incision at the level of the anterior rectus sheath. The incision should be long enough to allow delivery of the
infant without difficulty. This incision is made in obese women and in those requiring immediate delivery.
2. Modified Pfannensteil Incision –Lower transverse slightly curvilinear incision is made at the level of the
pubic hairline and extended a little beyond the lateral borders of the rectus muscles. This kind of incision is
stronger with less possibility of dehiscence of hernia formation. This type of incision is made on thin women.
Repeat cesarean section takes longer to perform after this type of incision because if scarring.
Nursing Consideration in Cesarean birth
Preoperative Nursing considerarition:
➢ A full history and physical examination.
➢ Past medical and surgical history.
➢ Current medications.
➢ Hx of drug allergies.
➢ Indication for the C/S.
➢ Consent for the surgery.
➢ Laboratory investigations – PCV, Urinalysis, EU/Cr. More extensive investigations in complicated cases
like hypertension, cardiac diseases etc. patients are individualised in such cases.
➢ Pass indwelling Folley urethral catheter into the bladder and retain.
➢ During transfer to the theatre, and during anaesthasia, patient should lie on her left lateral side with a
wedge on her right buttocks to prevent to prevent supine hypotension.
➢ Pre – medication with antacid is standard.
➢ Prophylatic antibiotics before the surgery.
Postoperative Nursing consideration:
➢ Ensure safety of the patient
➢ Maintain patent airway.
➢ Watch for signs of hemorrhages
Complications of Cesarean Section:
➢ Haemorrhage which may lead to anaemia.
➢ Injury to maternal organs – bladder, blood vessels, uterus, bowel.
➢ Injury to neonate.
➢ Wound infection.
➢ Deep vein thrombosis.
➢ Endometritis.
➢ Maternal mortality.
➢ Anaesthetic complications
