cesarean section (c-section)

7/31/2019 Cesarean Section (C-section)

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CESAREAN SECTION(C-SECTION)

Andrea Kalaba


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C-section, Caesarian section,Caesarean section, Caesar, etc.

Surgical incision of the abdominal wall and uterus to deliver afetus

usually performed when a vaginal delivery would put the

baby's or mother's life or health at risk Recently- preformed upon requestfor childbirths that may

have been natural


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HISTORY

Bindusara (born c. 320 BC, ruled 298 c.272BC), the second Mauryan Samrat (emperor) ofIndia, is said to be the first child born bysurgery

The name comes from traditional belief that

Julius Caesar was delivered by this operation(???)

Mothers usually died; the first recorded womansurviving a Caesarean section was in the1580s, in Siegershausen, Switzerland

European travelers in the Great Lakes region

of Africa during the 19th century observedCaesarean sections being performed on aregular basis

The first modern Caesarean section wasperformed by German gynecologist FerdinandAdolf Kehrer in 1881.


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SUCCESSFUL CAESAREANSECTIONPERFORMEDBYINDIGENOUSHEALERSINKAHURA, UGANDA. ASOBSERVEDBY R. W. FELKININ 1879.


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TYPES

Type of incision:

Horizontal (lower uterine)

Vertical (classical)

Urgency:

Emergency (Unplanned, Critical and Crash)

Planned (Scheduled and Elective)


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PROCEDURE

Both general and regional anaesthesia (spinal, epidural orcombined spinal and epidural anaesthesia) are acceptable

Regional anaesthesia is preferred: it allows the mother to beawake and interact immediately with her baby, other advantagesinclude the absence of typical risks of general

anesthesia: pulmonary aspiration of gastric contentsand intubation

General anesthesia: heavy, uncontrolled bleeding and veryurgent cases, when there is no time to perform a regionalanesthesia


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Initial incision and multiple layersof incisions

The uterine incision


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Suctioning amniotic fluidsDisengaging baby from the pelvisand babys head is born


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Suctioning the BabyBabys shoulders and body

born


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Uterine repair Mother and newborn baby


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RECOVERY

After delivery: recovery room (for about three hours- woman isclosely monitored)

If everything is well, woman is moved to postpartum room with IV andurinary catheter still in place

women are encouraged to be out of bed within six hours after

surgery and usually can begin eating within 24 hours if they arepassing gas

Three to five days after delivery patient is dissmised- there should beno strenuous work for up to six months


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Contracted pelvis

a pelvis that is abnormally small in oneor more principal diameters and thatconsequently interferes with normalparturition

Cephalopelvic disproportion

an obstetric condition in which ababy's head is too large or a mother'sbirth canal too small to permit normallabor or birth

Abruptio placentae

Placenta previa Fetal distress (hypoxia)

Breech or shoulder presentation(fetal malrepresentation)

INDICATIONS


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RISKS

Mother Higher mortality rate than in

vaginal birth

Abdominal surgery risks(postoperative adhesions, incisional

hernias, wound infections)

Anaesthesia risk

Severe blood loss

Postdural-puncture spinalheadaches

More likely to haveproblems with laterpregnancies (????)

Child Transient tachypnea of the

newborn ( wet lung)

Potential for early deliveryand complications

Injuries with scalpel andfractures

Higher infant mortality risk

the risk of death in the first 28days of life: 1.77 per 1,000

live births among women whohad C-sections/ 0.62 per1,000 for women whodelivered vaginally


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PROFESSOR DEIRDRE MURPHY

Professor of Obstetrics and Head ofDepartment (Trinity College Dublin)

clinical academic and an obstetricianwith clinical expertise in high riskpregnancy and labour ward care

research interests are focused on

maternal and neonatal health,intrapartum care and womensexperiences of childbirth and obstetricintervention

international profile in the area ofoperative delivery

worked as Consultant Senior Lecturerin Maternal Medicine at the Universityof Bristol, Professor of Obstetrics andGynaecology at the University ofDundee


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OXYTOCINBOLUSVERSUSOXYTOCIN

BOLUSANDINFUSIONFORCONTROLOF

BLOODLOSSATELECTIVECAESAREANSECTION: DOUBLEBLIND, PLACEBO

CONTROLLED, RANDOMISEDTRIAL

Murphy D., Sheehan SR, Montgomery AA, Carey M, McAuliffeFM, Eogan M, Gleeson R, Geary M, ECSSIT Study Group

BMJ 2011;343:120-31


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INTRODUCTION

The aim of the study was to determine the effects ofadding an oxytocin infusion to bolus oxytocin onblood loss at elective caesarean section


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SAMPLEAND METHODS

2069 women booked for elective caesarean section at

term with a singleton pregnancy excluded placenta praevia, thrombocytopenia, coagulopathies,

previous major obstetric haemorrhage (>1000 mL), or knownfibroids; women receiving anticoagulant treatment; those who didnot understand English; and those who were younger than 18years

Double blind, placebo controlled, randomised trial Intervention group: intravenous slow 5 IU oxytocin bolus over

1 minute and additional 40 IU oxytocin infusion in 500 mL of0.9% saline solution over 4 hours (bolus and infusion)

Placebo group: 5 IU oxytocin bolus over 1 minute and 500 mLof 0.9% saline solution over 4 hours (placebo infusion) (bolus

only).

conducted from February 2008 to June 2010 in fivematernity hospitals in the Republic of Ireland


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RESULTS

no difference in the occurrence of major obstetrichaemorrhage between the groups

the need for an additional uterotonic agent in thebolus and infusion group was lower than that in thebolus only group

women were less likely to have a major obstetrichaemorrhage in the bolus and infusion group thanin the bolus only group if the obstetrician was junior

rather than senior


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CONCLUSION

The addition of an oxytocin infusion after caesareandelivery reduces the need for additional uterotonicagents but does not affect the overall occurrence ofmajor obstetric haemorrhage.


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QUESTIONS, PLEASE


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THANK YOU!

cesarean section (c-section)

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