Beruflich Dokumente
Kultur Dokumente
Ass. Prof.
Angalva Elena
Nikolaevna
MD, PhD.
Cesarean Section
The term cesarean delivery is defined as the
delivery of a fetus through a surgical incision
through the abdominal wall (laparotomy) and
uterine wall (hysterotomy) .
The exact origin of the term cesarean is unclear.
The term cesarean may have arisen in the
Middle Ages from the Latin verb caedere (to
cut). Children of such births were referred to
as caesones
Indications
Maternal
Fetal
Procedures
Abdominal incisions
Procedures
Procedure
Procedures
Uterine Incision
Upon entering the peritoneal cavity, inspect the lower abdomen. The uterus is
palpated and commonly is found to be dextrorotated such that the left
round ligament is more anterior and closer to the midline. Dissect the
bladder free of the lower uterine segment. Grasp the loose uterovesical
peritoneum with forceps, and incise it with Metzenbaum scissors. The
incision is extended bilaterally in an upward curvilinear fashion. The lower
flap is grasped gently, and the bladder is separated from the lower uterus
with blunt and sharp dissection. A bladder blade is placed to both displace
and protect the bladder inferiorly and to provide exposure for the lower
uterine segment (the acontractile portion of the uterus).
One of essentially 2 incisions can be made on the uterus, either a transverse or
vertical incision. The decision for the type of incision is based on several
factors, including fetal presentation, gestational age, placental location, and
presence of a well-developed lower uterine segment.
In more than 90% of cesarean deliveries, a low transverse (Monroe-Kerr)
incision is made. The incision is made 1-2 cm above the original upper
margin of the bladder with a scalpel. The initial incision is small and is
continued into the uterine wall until either the fetal membranes are
visualized or the cavity is entered (take care to not injure the underlying
fetus
Procedure
Procedure
Uterine Incisions
Procedure
Delivery
When the fetus is delivered, the umbilical cord is doubly clamped and
cut. Blood is obtained from the cord for fetal blood typing, and a
segment of cord is placed aside for attaining blood gas results if a
concern exists regarding fetal status. Following delivery, oxytocin
(20 U) is placed in the intravenous fluid to increase contractions of
the uterus. The placenta usually is delivered manually. Awaiting
spontaneous delivery of the placenta with gentle traction is more time
consuming but is associated with decreased blood loss, lower risk of
endometritis, and lower maternal exposure to fetal red blood cells,
which can be important to Rh-negative mothers delivering an Rhpositive fetus.
After delivery of the baby, administer prophylactic antibiotics. A single
dose of ampicillin or a first-generation or second-generation
cephalosporin is appropriate. If the surgery is prolonged, a second
dose can be administered later. If the patient has chorioamnionitis,
broader-spectrum antibiotics, such as gentamicin and clindamycin or
Unasyn, are indicated and should be continued in the postoperative
period until the patient is afebrile.
Procedure
Procedure
Procedure
Body Delivery
Procedure
Placental
Delivery
Complications
Intraoperative Complications
Uterine lacerations
Bladder injury
Ureteral injury
Bowel injury
Uterine atony
Postoperative Complications
Postpartum endomyometritis
Wound infection
Fascial dehiscence
Urinary tract infection
Thromboembolic complications
Pelvic thrombophlebitis