CESAREAN SECTION (C-SECTION)

Andrea Kalaba

CESAREAN

SECTION

C-section, Caesarian section,Caesarean section, Caesar, etc. Surgical incision of the abdominal wall and uterus to deliver a fetus usually performed when a vaginal delivery would put the baby's or mother's life or health at risk Recently- preformed upon request for childbirths that may have been natural

HISTORY

Bindusara (born c. 320 BC, ruled 298 c.272 BC), the second Mauryan Samrat (emperor) of India, is said to be the first child born by surgery The name comes from traditional belief that Julius Caesar was delivered by this operation (???) Mothers usually died; the first recorded woman surviving a Caesarean section was in the 1580s, in Siegershausen, Switzerland European travelers in the Great Lakes region of Africa during the 19th century observed Caesarean sections being performed on a regular basis The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.

SUCCESSFUL CAESAREAN SECTION PERFORMED BY INDIGENOUS HEALERS IN KAHURA, UGANDA. AS OBSERVED BY R. W. FELKIN IN 1879.

TYPES

Type of incision:

Horizontal (lower uterine) Vertical (classical)

Urgency:
Emergency (Unplanned, Critical and Crash) Planned (Scheduled and Elective)

PROCEDURE

Both general and regional anaesthesia (spinal, epidural or combined spinal and epidural anaesthesia) are acceptable
Regional anaesthesia is preferred: it allows the mother to be awake and interact immediately with her baby, other advantages include the absence of typical risks of general anesthesia: pulmonary aspiration of gastric contents and intubation General anesthesia: heavy, uncontrolled bleeding and very urgent cases, when there is no time to perform a regional anesthesia

Initial incision and multiple layers of incisions

The uterine incision

Suctioning amniotic fluids

Disengaging baby from the pelvis and babys head is born

Suctioning the Baby

Babys shoulders and body born

Uterine repair

Mother and newborn baby

RECOVERY

After delivery: recovery room (for about three hours- woman is closely monitored) If everything is well, woman is moved to postpartum room with IV and urinary 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 are passing gas Three to five days after delivery patient is dissmised- there should be no strenuous work for up to six months

INDICATIONS

Contracted pelvis

a pelvis that is abnormally small in one or more principal diameters and that consequently interferes with normal parturition an obstetric condition in which a baby's head is too large or a mother's birth canal too small to permit normal labor or birth

Cephalopelvic disproportion

Abruptio placentae Placenta previa Fetal distress (hypoxia) Breech or shoulder presentation (fetal malrepresentation)

RISKS

Mother

Child

Higher mortality rate than in vaginal birth Abdominal surgery risks

(postoperative adhesions, incisional hernias, wound infections)

Anaesthesia risk Severe blood loss Postdural-puncture spinal headaches More likely to have problems with later pregnancies (????)

Transient tachypnea of the newborn ( wet lung) Potential for early delivery and complications Injuries with scalpel and fractures Higher infant mortality risk

the risk of death in the first 28 days of life: 1.77 per 1,000 live births among women who had C-sections/ 0.62 per 1,000 for women who delivered vaginally

RESEARCH PAPER

PROFESSOR DEIRDRE MURPHY

Professor of Obstetrics and Head of Department (Trinity College Dublin) clinical academic and an obstetrician with clinical expertise in high risk pregnancy and labour ward care research interests are focused on maternal and neonatal health, intrapartum care and womens experiences of childbirth and obstetric intervention international profile in the area of operative delivery worked as Consultant Senior Lecturer in Maternal Medicine at the University of Bristol, Professor of Obstetrics and Gynaecology at the University of Dundee

OXYTOCIN

BOLUS VERSUS OXYTOCIN

BOLUS AND INFUSION FOR CONTROL OF BLOOD LOSS AT ELECTIVE CAESAREAN SECTION: DOUBLE BLIND, PLACEBO

CONTROLLED, RANDOMISED TRIAL

Murphy D., Sheehan SR, Montgomery AA, Carey M, McAuliffe FM, Eogan M, Gleeson R, Geary M, ECSSIT Study Group
BMJ 2011;343:120-31

INTRODUCTION

The aim of the study was to determine the effects of adding an oxytocin infusion to bolus oxytocin on blood loss at elective caesarean section

SAMPLE

AND

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 known fibroids; women receiving anticoagulant treatment; those who did not understand English; and those who were younger than 18 years

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

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

RESULTS
no difference in the occurrence of major obstetric haemorrhage between the groups the need for an additional uterotonic agent in the bolus and infusion group was lower than that in the bolus only group women were less likely to have a major obstetric haemorrhage in the bolus and infusion group than in the bolus only group if the obstetrician was junior rather than senior

CONCLUSION

The addition of an oxytocin infusion after caesarean delivery reduces the need for additional uterotonic agents but does not affect the overall occurrence of major obstetric haemorrhage.

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