History, development and clinical implication

CAESAREAN SECTION

Prof. dr. Mgs. H. Usman Said, SpOG (K)

Subbagian Fertilitas Endokrinologi & Reproduksi Departemen Obstetri & Ginekologi FK. Unsri / RSUP Dr. Muhammad Hoesin Palembang 2010
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History

Caesarean Mitos : J. caesar dilahirkan dari ibu Aeralius

The extraction of Asclepius from the abdomen of his mother Coronis by his father Apollo. Woodcut from
the 1549 edition of Alessandro Beneditti's De Re Medica. 2

History
J. Caesar melakukan invasi ke Inggeris, Ibu merestuinya

One of the earliest printed illustrations of Cesarean section. Purportedly the birth of Julius Caesar. A live infant being surgically removed from a dead woman. From Suetonius' Lives of the Twelve Caesars, 1506 woodcut.

Developing country
Seksio dilakukan pada ibu yang sekarat/meninggal

Successful Cesarean section performed by indigenous healers in Kahura, Uganda. As observed by R. W. Felkin in 1879.

 Embriotomi

Craniotomy. Perforation of the skull, removal of cranial contents, and extraction of the collapsed skull.

Contraindication
Fetal malformation < 28 week pregnancy DIC

Indication
Philosophy : The procedure should be on scientific base , for the sake/benefit of the patient and with least burden.

Risk

Risk of maternal death due to CS

Trend of rising CS rate

Belanda dengan angka seksio yang rendah mempunyai angka kematian ibu dan perinatal yang rendah di dunia

Dikutip dari: E.J. Quilligan, 2001

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Dikutip dari: E.J. Quilligan, 2001

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Indication of CS by country

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Indications
Dystocia Placenta previa & abruptio Fetal distress Shoulder pres. Prev. CS Breech Triplets++

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Dystocia

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Antepartum hemorrhage

Indikator plasenta previa USG pada kehamilan > 37 mgg

Dikutip dari: Cuningham dkk, 2001

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Dystocia
The use of PARTOGRAM CPD head or abdominal circumference of >35 cm; Contracted pelvis (Ro or CT) - incidence of 1% Malpresentation - posterior occiput Malposisi
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Vasa Uterina
Risk of laceration U incision is the best avoiding the vessels Hemostatic stitch perpendicular to the vessels

Dikutip dari: Cuningham dkk, 2001

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Opening the low segment

Lebih baik dengan cara avue : Gunting arah keatas ! Bentuk U Hindari pelebaran tumpul mencapai vasa uterina

Dikutip dari: Cuningham dkk, 2001

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Dikutip dari: Cuningham dkk, 2001

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Fetal Hypoxia
Severe Preeclampsia FDJP /Biophysical profile < 6 CTG : Severe deceleration, non reactive Thick meconium Placental Insufficiency : Postterm > 42 mgg Prolaps t.pusat READY FOR RESCUCITATION
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Complications
PROBLEM laceration hematoma Bleeding from LS PREVENTION Uincision Hemostatic stitches Stitches, tampon

Delivery of infant
placenta di depan

forsep, vacuum, extraction insisi longitudinal rdh

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Complication
Robekan Hematoma Perdarahan dari insersi Atonia Kesulitan pengeluaran kepala Malposisi kepala

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Dikutip dari:W.C. Wong et al 2001

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Low longitudinal Incision

Indication :
preterm Placenta previa in anterior Shoulder pres.

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Emergency CS

INDIKASI: Keadaan umum buruk, risiko anestesi umm/regional CARA: Infiltrasi lidokain 0.5% , Atau: ketamin 50 mg bolus + Tetes Ketamin 100 mg/500 RL
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Intraoperative

Spinal is the best Antiseptic Universal precaution Facilities, vital monitoring recording

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Dikutip dari: E.J. Quilligan, 2001

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Dikutip dari: E.J. Quilligan, 2001

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Trends

Amerika berusaha untuk mencapai tingkat angka seksio 15%

Dikutip dari: Cuningham dkk, 2001

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When is it safe for next pregnancy ?

Risik of uterine rupture will increase if interval is less than 18 months. Evaluation of the thickness of low segmen at term. Rozenberg (1996): risk of uterine rupture increase if < 3.5 mm sensitifity 88%, specificity 99%.
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VBAC

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Rebound effect

Due to rate of CS VBAC

Dikutip dari: Cuningham dkk, 2001

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Contraindication for VBAC

Contracted pelvis Macrosomia Classic incision or deep myomectomy Overdistended Readiness for emergency CS (?)

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Dikutip dari: E.J. Quilligan, 2001

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Dikutip dari: Cuningham dkk, 2001

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Dikutip dari: Cuningham dkk, 2001

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INFORMED CONSENT

Information on indication, risk and benefit

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AUDIT
Regular Maternal Perinatal meeting (weekly/monthly) Review for indications (e.g fetal distress) Morbidity Guidelines (EFM) May reduce the rate Report and dissemination
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