Cesarean Section

A Cesarean section (or Cesarean section in American English), also known as C-section or Caesar, is a surgical procedure in which incisions are made through a mother's abdomen (laparotomy) and uterus(hysterotomy) to deliver one or more babies.

According to incision made: 1. Classical incision made vertically through both the abdominal skin and the uterus. Advantage is that it is high the uterus so it can be used with a placenta previa to avoid cutting the placenta, disadvantage is that it leaves a wide skin scar and runs through the active contractile portion of the uterus. Because this type of scar could rupture during labor, it is likely that the woman will not be able to have a subsequent vaginal birth

2. Low segment Incision made horizontally across the abdomen just over the symphysis pubis and also horizontally across the uterus just over the cervix. Most common type of incision currently made; also termed as Pfannestiel incision or bikini incision because even a low-cut bathing suit would cover it

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According to emergence: 1. scheduled Emergency for placenta previa, abruptio placenta, or fetal distress

1. Stress response 2. Interference with body defenses 3. Inerference with circulatory function 4. Interference with body organ function 5. interference with self-image or selfesteem
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Preperative interview: 1. Any past surgery 2. Secondary illnesses 3. Currently taking any medications 4. Any allergies to foods or drugs This is to help establish surgical risk Other: 5. womans knowledge about the procedure 6. Length of ospitalization that will be required 7. Postsurgical equipment will be used such as an IV or IC

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Establishing Operative Risk 1. Poor nutritional status obese mothers are at risk because such condition interferes wound healing Age young adolescent and those that are 35 years old above 3. General health persons with secondary illness (DM, anemia, etc.) 4. Fluid and electrolyte balance 5. Psychological condition
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Surgical Procedure: 1. Transport from stretcher to the OR table 2. Administration of anesthesia nurse helps in positioning the patient ***curved back 3. Skin preparation extends from under the breasts down to the thighs includes pubic hair shave with smooth strokes 4. Surgical incision helps in draping the client

Labor isn't progressing. Stalled labor is the most common reason for a C-section. Perhaps the cervix isn't opening enough despite strong contractions over several hours. Or the baby's head may simply be too big to pass through the mothers birth canal.

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The baby's heartbeat suggests reduced oxygen supply. If the baby isn't getting enough oxygen or your doctor is concerned about changes in your baby's heartbeat, he or she may recommend a prompt C-section.

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If the baby is in an abnormal position. A baby whose feet or buttocks enter the birth canal before the head is in the breech position. If the doctor isn't able to move the baby into a more favorable position before labor begins, patient may need a C-section to reduce the risk of complications. A Csection is also needed if your baby is lying horizontally across your uterus.
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If carrying twins, triplets or other multiples. When carrying multiple babies, it's common for one or more of the babies to be in an abnormal position

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There's a problem with your placenta. If the placenta detaches from your uterus before labor begins (placental abruption) or the placenta covers the opening of your cervix (placenta previa), C-section is often the safer option.

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There's a problem with the umbilical cord. A C-section may be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.

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There's a problem with the umbilical cord. A C-section may be recommended if a loop of umbilical cord slips through your cervix ahead of your baby or if the cord is compressed by the uterus during contractions.

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Your baby is very large. Some babies are simply too big to safely deliver vaginally. Typically this is only a factor if you have diabetes.

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You have a health problem. If you have a condition such as diabetes, heart disease or lung disease, your doctor may induce labor early to reduce the risk of pregnancy-related complications. If the induction isn't successful, you may need a C-section. In other circumstances, a C-section may be recommended if you have an active genital herpes infection or another condition that your baby might acquire while passing through the birth canal.

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Your baby has a health problem. A Csection may be safer for babies with certain developmental problems, such as failure of the spine to close properly (spina bifida) or excess fluid in the brain (hydrocephalus).

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You've had a previous Csection. Depending on the type of incision and other factors, you may be able to attempt a vaginal delivery after a previous C-section. In some cases, however, your doctor may recommend a repeat C-section.

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Risk for the baby: Breathing problems. Babies born by Csection are more likely to develop a breathing problem marked by abnormally fast breathing during the first few days after birth (transient tachypnea). Elective Csections done before 39 weeks of pregnancy or without proof of the baby's lung maturity may increase the risk of other breathing problems, including respiratory distress syndrome.
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Fetal injury. Although rare, accidental nicks to the baby's skin can occur during surgery.

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FOR THE MOTHER Inflammation and infection of the membrane lining the uterus.This condition known as endometritis may cause fever, chills, back pain, foul-smelling vaginal discharge and uterine pain. It's often treated with intravenous (IV) antibiotics.

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Increased bleeding. You may lose more blood with a Csection than with a vaginal birth. However, blood transfusions are rarely needed.

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Urinary tract infection. You may develop a urinary tract infection in the bladder or kidneys.

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Decreased bowel function. Any abdominal surgery slows the movement of waste material through your intestines. Some medications for pain relief may further contribute to this problem, leading to constipation.

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Reactions to anesthesia. After regional anesthesia, a small number of women may experience a headache caused by a leak of the fluid around the spinal canal into the tissues of the back. Allergic or adverse reactions to the anesthetic also are possible

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Blood clots. The risk of developing a blood clot inside a vein especially in the legs or pelvic organs is about four times greater after a C-section than after a vaginal delivery. If a blood clot travels to your lungs (pulmonary embolism), the damage can be lifethreatening. Your doctors will take steps to prevent blood clots. You can help, too, by walking frequently soon after surgery.
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Wound infection. An infection at or around the incision site is possible. When a wound is infected, it may open at the skin and release pus.

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Additional surgeries. Although rare, surgical injuries to nearby organs can occur during a Csection. If this happens, additional operations may be needed
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Increased risks during future pregnancies. After a C-section, you face a higher risk of potentially serious complications including bleeding, placenta previa, abnormal fetal positions and tearing of the uterus along the scar line from the prior Csection (uterine rupture) in a subsequent pregnancy than you would after a vaginal delivery.
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Maternal and child health nursing by Philiterri http://www.mayoclinic.com http://www.en.wikipedia.com

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