Cesarean

Section
Presented By: Richard Lim

Caesarean Section
Definition
Removal of a fetus from the uterus by
abdominal incision,
After 28 weeks of pregnancy
Its called hysterotomy, if removal is
done before 28 weeks of pregnancy

Cesarean Section
The

word cesarean is derived from the

Latin caedore which means to cut
At one time , there was a popular belief
that Julies Caesar was born by a
cesarean birth and the procedure was
named from him

Assessment
Assessment

as to whether a woman will

be a good candidate for surgery is
sometimes done throughout pregnancy
and sometimes done very quickly in an
emergency.
Either way, assessment must include
both physiologic and psychological stays
and preparedness

Nursing Diagnosis
Risk

for infection related to a surgical

incision
Fear related to impending surgery
Pain related t0 a surgical incision
Deficient fluid volume related to blood
loss from surgery
Powerlessness related to medical need
of cesarean birth

Outcome Identification and

Planning
The

sane outcome applies to a woman

giving birth by cesarean as a woman
giving birth vaginally: a healthy mother
and a healthy child
Because cesarean birth decisions can be
made suddenly, planning can be limited
to only a few minutes.

Implementation
Many

interventions focus on teaching

and support, because the more a
woman understands about what is
happening to her, the more she can
accept and cooperate with the
procedure.

Outcome Evaluation
Patient

state that she understands the

reason for a cesarean birth
Patient state that she felt well prepared for
cesarean birth even in a light of an
emergency
Patient remains free of signs and
symptoms of infection after cesarean birth
Patient states that incisional pain is
controlled and tolerable

Cesarean Birth
1.
2.

Scheduled Cesarean Birth

Emergency Cesarean Birth

Scheduled Cesarean Birth

In

the 1950s, cesarean birth became a

status symbol when Hollywood stars
asked to have cesarean births to save
themselves the strain of labor and in
some instance to schedule the birth
conveniently between movie contracts.
Average woman came to think that a
Cesarean birth not a surgical procedure
but as an east method of painless birth

Emergency Cesarean
Birth
Done for reason such as;
Placenta previa
Abruptio placentae
Fetal distress
Failure to progress in labor

Emergency Cesarean
Birth
An Emergency Cesarean Birth carries with it
the risk of any emergency surgery:
The woman may not be a prime candidate for
anesthesia
Psychologically unprepared for the
experience
The woman may have a fluid and electrolytes
imbalance and be both physically and
emotionally exhausted from long labor

Cesarean Birth
May

reduce the transfer of Human

Immunodeficiency Virus (HIV)
Hepatitis C
Herpes type 2 from mother to new born
So its recommended for woman who are
HIV positive.
It can reduce mortality among infants
presenting breech

Risk of Cesarean Section

Because the cesarean delivery involves major
surgery and anesthesia, there are some
disadvantage compared to vaginal delivery
Cesarean is associated with a higher rate of
injury to abdominal organs( bladder, bowel,
blood vessels) infections (wounds, uterus,
urinary track) and thromboembolic (blood
clotting) complication than vaginal delivery

Risk of Cesarean Section

Cesarean

surgery can interfere with motherinfant interaction in the delivery

Recover take longer than vaginal delivery
Cesarean delivery is associated with a higher
risk that the placenta will attach to uterus
abnormally in subsequent pregnancies, which
can lead to serious complications
Cutting the uterus to deliver the baby
weakens the uterus, increasing the uterine
rupture in future pregnancy

Cesarean Delivery on Maternal

Request
After

previous cesarean Mothers who

have previously had a cesarean section
are more likely to have cesarean section
for future pregnancies than mother who
have never had cesarean section.
Twins for otherwise twin pregnancies
were both twins are head down a trial
of vaginal delivery is recommended at
between 37 and 38 weeks

Cesarean Delivery on Maternal

Request
Breech

birth is the birth of the baby

from breech presentation, in which the
baby exists the pelvis with the buttocks
or feet first as opposed to the normal
head first presentation. Breech
presentation, the fetal heart sound are
heard above the umbilicus

Infant Risk
There are few risk of cesarean delivery for
the infant. One risk is birth trauma.
Temporary respiratory problems are more
common after cesarean birth because
baby is not squeezed through the
mothers birth canal. This reduces the
reabsorption of fluid in infants lungs.

Potential Complication
The most common complications related
to cesarean delivery include
Infection
hemorrhage,
injury to pelvic organs,
and blood clots

Potential Complication
1.

Infection - The risk of postoperative

uterine infection (endometritis) varies
according to several factors, such as
whether labor had started and whether
the water was broken. Endometritis is
treated with antibiotics.

Potential Complication
2. Hemorrhage - One to two percent of all
women having cesarean deliveries require a
blood transfusion because of hemorrhage
(excessive bleeding). Hemorrhage usually
responds to medications that cause the
uterus to contract or procedures to stop the
bleeding. In rare cases, when all other
measures fail to stop bleeding, a
hysterectomy (surgical removal of the uterus)
may be required.

Potential Complication
3. Injury to Pelvic Organ - Injuries to the
bladder or intestinal tract occur in
approximately one percent of cesarean
deliveries.

Potential Complication
4. Blood Clots - Women are at increased risk of
developing blood clots in the legs (deep vein
thrombosis or DVT) or the lungs (pulmonary
embolus) during pregnancy and the postpartum
period. This risk is further increased after cesarean
delivery. The risk can be reduced by using a device
that gently squeezes the legs during and after
surgery, called an intermittent compression
device. Women at high risk of DVT may be given
an anticoagulant (blood thinning) medication to
reduce the risk of blood clots.

Types of Anesthesia
Spinal
General
Epedural
Local

Spinal Anesthesia
It is best and the cheapest
Patient remains conscious
Less incidence of cardiac arrest
Sometimes difficult for anesthetist to find space due
to lumbar lordosis of pregnancy
Sometimes there is fall of blood pressure
Post operative spinal headache
Spinal anesthesia should not be given if patient has
already low BP or baby has transverse presentation
or deeply engaged head or failed forceps or vacuum
delivery

General Anesthesia
Many times patient demand GA
Drug used is I.V Pentothal Sodium with
Oxygen and Nitrous Oxide and muscle
relaxant
If the patient has taken food,
regurgitation complication like aspiration
pneumonia may occur
Deeply anesthesia, only to be given after
baby has been deliver

Epidural Anesthesia
These

days patient are asking for

painless delivery and for that, many
time continuous epidural anesthesia is
given. Ig the trial of labor fails, the
patient may be taken cesarean section
or forceps delivery. In that case
cesarean may be performed in the same
epidural anesthesia. It is good
anesthesia with less of a fall of blood
pressure

Local Anesthesia
In

this anesthesia, the surgery may not

be as comfortable as spinal or general
anesthesia.
Very rarely used and is not even briefly
mention.

Procedure

After being admitted to the hospital, a

woman may be given an oral dose of an
antacid to reduce the acidity of the stomach
contents. Another medication may be given
to reduce the secretions in the mouth and
nose. An intravenous line will be placed into
the hand or arm, and an electrolyte solution
will be infused. Monitors will be placed to
keep track of blood pressure, heart rate,
and blood oxygen levels.

Procedure
AnesthesiaThe

woman is usually
accompanied to an operating room
before anesthesia is administered. A
spouse or partner can usually stay with
the woman in the operating room.

Procedure

There are two types of anesthesia used

during cesarean delivery: regional and less
commonly, general. For a planned cesarean
delivery, regional anesthesia is usually
performed. Meeting with the
anesthesiologist allows the woman to ask
specific questions about anesthesia, and
allows the anesthesiologist to identify any
medical problems that might affect the type
of anesthesia that is recommended.

Procedure
With

epidural and spinal anesthesia, the

anesthetic is injected near the spine,
which numbs the abdomen and legs to
allow the surgery to be pain-free while
allowing the mother to be awake.

Procedure

General anesthesia, now infrequently used for

cesarean, induces unconsciousness. This means that
the mother will not be awake or aware during the
procedure. After the anesthesia is given, the woman
will fall asleep within 10 to 20 seconds and a tube
will be placed in the throat to assist with breathing.
General anesthesia carries a greater risk of
complications than epidural or regional anesthesia
because of the need for an endotracheal (breathing)
tube and because drugs given to the mother affect
the infant.

Procedure
Women

who have general anesthesia will not be

awake during the cesarean delivery. Regional
anesthesia is generally preferred because it allows the
mother to remain awake during the procedure, enjoy
support from staff and a family member, experience
the birth, and have immediate contact with the infant.
It is usually safer than general anesthesia.
After the anesthesia is given, a catheter is placed in
the bladder to allow urine to drain out during the
surgery and reduce the chance of injury to the
bladder. The catheter is usually removed within 24
hours after the procedure.

Procedure

Skin incisionThere are two basic types

of incision: horizontal (transverse or "bikini
line") and vertical (midline). Most women
have a transverse skin incision, which is
made 1 to 2 inches above the pubic hair
line. The advantages of this type of incision
include less postoperative pain, more rapid
healing, and a lower chance that the
wound will separate during healing.

Procedure
Less

commonly, the woman will have a

vertical ("up and down") skin incision in
the midline of the abdomen. The
advantages of this type of incision
include a slightly more rapid access to
the uterus

Procedure

Uterine incisionThe uterine incision

can also be either transverse or vertical.
The type of incision depends upon several
factors, including the position and size of
the fetus, the location of the placenta,
and the presence of fibroids. The main
consideration is that the incision must be
large enough to allow delivery of the fetus
without causing trauma.

Procedure
The most common uterine incision is transverse.
However, a vertical incision may be required if the baby
is breech or sideways, if the placenta is in the lower front
of the uterus, or if there are other abnormalities of the
uterus.
After opening the uterus, the baby is usually removed
within seconds. After the baby is delivered, the umbilical
cord is clamped and cut and the placenta is removed.
The uterus is then closed. The abdominal skin is closed
with either metal staples or reabsorbable sutures.
After the mother and baby are stable, she or her partner
may hold the baby.

Postoperative Care
After

surgery is completed, the woman will

be monitored in a recovery area. Pain
medication is given, initially through the IV
line, and later with oral medications.
When the effects of anesthesia have worn
off, generally within one to three hours after
surgery, the woman is transferred to a
postpartum room and encouraged to move
around and begin to drink fluids and eat
food.

Postoperative Care
Breastfeeding

can usually begin anytime

after the birth. A pediatrician will examine
the baby within the first 24 hours of the
delivery. Most women are able to go home
within three to four days after delivery
Staples are usually removed within three to
seven days of delivery, while reabsorbable
sutures, which are now recommended over
staples, are absorbed by the body and do
not need to be removed.

Postoperative Care
The

abdominal incision will heal over the

next few weeks. During this time, there
may be mild cramping, light bleeding or
vaginal discharge, incisional pain, and
numbness in the skin around the incision
site. Most women will feel well by six
weeks postpartum, but numbness
around the incision and occasional aches
and pains can last for several months.

Postoperative Care
After

going home, the woman should

notify her healthcare provider if she
develops a fever (temperature greater
than 100.4 F [38 C]), if pain or
bleeding worsens, or there are other
concerns.

A Team Performing a Cesarean

Section

Transvaginal Ultrasonography

Of a uterus years after a Cesarean

Section, showing characteristic scar
formation

A 7 Week Old Cesarean Section

scar and linea nigra visible

Suturing of the Uterus

Closed Incision for low transverse

abdominal incision after stapling
has been complete

Pulling out of the Baby