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SECTIO CESAREANCASE PRESENTATION


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INTRODUCTION

Cesarean delivery is defined as the birth of

a fetus through incisions in the abdominal

wall (laparotomy) and the uterine wall

(hysterotomy).


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The reasons why the cesarean rate

quadrupled between 1965 and 1988

1. Women are having fewer children, thus, a greater percentage of births are

among nulliparas, who are at increased risk for cesarean delivery.

2. The average maternal age is rising, and older women, especially nulliparas,

are at increased risk of cesarean delivery

3. The use ofelectronic fetal monitoringis widespread. This technique isassociated with an increased cesarean delivery rate compared with

intermittent fetal heart rate auscultation

4. The vast majority of fetuses presenting as breech are now delivered by

cesarean

5. The incidence ofmidpelvic forceps and vacuum deliveries has decreased

6. Rates oflabor induction continue to rise, and induced labor, especially

among nulliparas, increases the risk of cesarean

7. The prevalence ofobesityhas risen dramatically, and obesity also

increases the risk of cesarean delivery


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Indications


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Technique for Cesarean Delivery

midline vertical or a suprapubic transverseincision is usedAbdominal

Incisions

An infraumbilical midline vertical incision The incision should be of sufficient length to allow

delivery of the infant without difficultyVerticalIncision

The incision is made at the level of the pubic hairline and isextended beyond the lateral borders of the rectus muscles. After the

subcutaneous tissue has been separated from the underlying fasciafor 1 cm or so on each side, the fascia is incised transversely the fulllength of the incisionTransverseIncisions

For most cesarean deliveries, the transverse incision is theoperation of choice

advantages : (1) easier to repair, (2) located at a site least likely to

rupture during a subsequent pregnancy, and (3) does not promoteadherence of bowel or omentum to the incisional line

Uterine

Incisions


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Transverse Cesarean Incision


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Delivery of the Infant

head iselevatedgently withthe fingersand palm

through theincision

The

shouldersthen aredelivered

using gentletraction plus

fundalpressure

The rest ofthe bodyreadilyfollows

I.V infusion

containing abouttwo ampules or20 units of

oxytocin per literof crystalloid isinfused at 10

mL/min until theuterus contracts

satisfactorily


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The cord isclamped, and theinfant is given to

the team memberwho will conduct

resuscitativeefforts as needed

The placenta isthen deliveredunless it has

already done sospontaneously

Fundal massage,begun as soon asthe fetus is

delivered, reducesbleeding and

hastens placentaldelivery


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Repair of the Uterus

1. The uterine incision is then closed with one or two layers of continuous 0 or number

1 absorbable suture. Chromic suture is used by most surgeons, but some prefer

synthetic nonabsorbable sutures


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Subsequent Care

Analgesia

For the woman of average size, meperidine, 75 to 100 mg, is givenintramuscularly as often as every 3 hours as needed for discomfort, or morphinesulfate, 10 to 15 mg, is similarly administered

Vital Signs assessed at least hourly for 4 hours and thereafter. Blood pressure, pulse,

temperature, uterine tone, urine output, and amount of bleeding are evaluated

Fluid Therapy and Diet

3 L of fluid should prove adequate during the first 24 hours after surgery

Bladder and Bowel Function

The bladder catheter most often can be removed by 12 hours postoperatively. Inuncomplicated cases

Solid food may be offered within 8 hours of surgery


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Subsequent Care

Ambulation

The woman should get briefly out of bed with assistance at least twice

Early ambulation lowers the risk of venous thrombosis and pulmonary embolism

Wound Care

the skin sutures or clips often can be removed on the fourth day after surgery

By the third postpartum day, bathing by shower is not harmful to the incision

Laboratory

when there was unusual blood loss or when there is oliguria or other evidenceto suggest hypovolemia

Breast Care

After delivery, the breasts begin to secrete colostrum, which is a deep lemon-yellow-colored liquid. It usually can be expressed from the nipples by thesecond day


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Sources

Williams Obstetrics

Medscape

Documents

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