Cesarean Section

What is a cesarean section?

A cesarean section, or c-section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. In certain circumstances, a c-section is scheduled in advance. In others, it's done in response to an unforeseen complication.

Organ Involved
The uterus is a dynamic female reproductive organ that is responsible for several reproductive functions, including menses, implantation, gestation, labor, and delivery. It is responsive to the hormonal milieu within the body, which allows adaptation to the different stages of a womans reproductive life.

 The uterus adjusts to reflect changes in ovarian steroid production during the menstrual cycle and displays rapid growth and specialized contractile activity during pregnancy and childbirth.

The five Most Common Causes of Cesarean Section

CS on Request Routine repeat cesareans . Dystocia (non-progressive labor) . Abnormal fetal presentation eg breech , transverse , cord presentation . Fetal distress .

PATHOPHYSIOLOGY
Due to hereditary reasons Post mature baby Diabetic mother Multi gravida mother Occipitoposteriorpositio n Brow presentation Face presentation Small pelvis Abnormally shape pelvis Tumors of the bones Childhood poliomyelitis Congenital dislocation of hips Congenital deformity of sacrum or coccyx Tumor likefibroids obstructing the birth passage Congenital rigidity of the cervix Scarring of the cervix due to previous operation Congenital vaginal septum

Increased fetal weight

Problems with fetal position/attitud e

Problems with the pelvis

Problems with the genital tract

Cont.

POOR FETAL DESCENT

PROLONGED 1st STAGE OF LABOR

CEPHALOPELVIC DISPROPORTION

CESAREAN SECTION

 Assist the woman and her family to prepare emotionally and psychologically for the procedure.

Consent for CS
Consent for CS should be requested after providing pregnant women with evidence based information and in a manner that respects the womans dignity, privacy, views and culture whilst taking into consideration the clinical situation.

Maternal Satisfaction during CS

Womens preferences for the birth, such as music playing in theatre, lowering the screen to see baby born, or silence so that the mothers voice is the first baby hears, and lowering the lights in theatre during CS are needed should be accommodated where possible. If CS is doing under regional anesthesia

Timing Of CS
Cesarean deliveries may be performed because of maternal or fetal problems that arise during labor, or they may be planned before the mother goes into labor Elective cesarean delivery elective caesarean section may be justified, but decisions must take into account the risk to the infant associated with delivery before 39 weeks' gestation It is now clear that respiratory distress syndrome is indeed seen in "term" infants and is a considerable source of morbidity and mortality in this group mechanical ventilation to treat presumed surfactant deficiency is 120 times more likely to be needed after elective delivery at 37-38 weeks than after delivery at 39-41 weeks Emergency cesarean section In cases of suspected or confirmed acute fetal compromise, delivery should be accomplished as soon as possible. The accepted standard is within 30 minutes.

Elective caesarian section (Planned operation)

Advantages are:Patient with empty stomach and surgeon usually with full breakfast Best anesthetist available at that time Best assistant and nursing staff. Disadvantages are :If wrong judgment, premature child may be born. Cervix may not be dilated and hence poor drainage of lochia Lower segment is not formed and hence uterine incision in lower part of upper segment.

Emergency caesarian section (Unplanned)

Working under adverse circumstances:Patient may be with full stomach and surgeon may be with eampty belly Odd working hours either of day or night Anesthetist, assistant and nursing staff may not be of your choice Advantage is :Mature child as patient is in labor Cervix is open, better drainage of lochia. Lower segment is well formed

Cesarean Section Anesthesia

Anesthesia is a type of medicine that keeps you from feeling pain during a procedure. For a cesarean section, spinal and epidural blocks are the most commonly used anesthetics, but general anesthesia is sometimes necessary. The kind of cesarean section anesthesia that will be used for your delivery will depend on several things, including your health and your baby's health.

Types of Cesarean Section Anesthesia The three types of ansethesia that may be used for a cesarean section include: Epidural Spinal General

Epidural and Spinal Blocks Epidural and spinal blocks are regional anesthetics, which means that they block pain and other sensations over a large part of your body, but not all of it. Both usually cause complete loss of sensation in the lower part of your body. For an epidural block, your lower back is washed with a special disinfectant solution. Then the anesthesiologist uses a local anesthetic to numb the area of insertion.

A tiny, flexible, plastic tube, called an epidural catheter, is inserted into your lower back and taped into position. The anesthetic can be injected through the catheter whenever you need it. Spinal anesthesia is given by injecting a small dose of medication, through a syringe, into your lower back. A spinal block will often take effect more quickly than an epidural block, but it may not last as long.

General Anesthesia Another option for cesarean section anesthesia is general anesthesia. This type of anesthesia can affect the baby, so spinal and epidural blocks are the preferred methods for planned cesarean sections. General anesthesia puts you into a deep sleep so that you do not feel any pain, pressure, or movement during the cesarean section. In order to do this, you will first be asked to breathe through an oxygen mask

 After you are in a deep sleep, a breathing tube will be placed into your windpipe to assist with your breathing throughout the operation. Throughout the cesarean section, your anesthesiologist and anesthesia care team will give you anesthesia and other medications, as required, through your IV and/or through your breathing tube.

Patients Position
The patient is placed Supine with a bolster under their right side to prevent excessive pressure on the Inferior Vena Cava.

Pre operative care To prepare the patient for anesthesia. A consent for operation is obtained. Laboratory examination such as urinalysis. General examination is done to assess patients nutrition and general health. The patient bowel should be emptied. The vulva and lower part of abdomen should be shave. The patient usuallty starved for 8-10 hours before the operation.

Post operative care After the surgery frequent monitoring of the vital signs and recording hourly. The Nurse should be in the patient side until conscious has regained. Post operative drugs are written out.