CESAREAN SECTION

Introduction

Cesarean section, C-section, or Cesarean birth is the surgical delivery of a baby through a cut (incision)
made in the mother's abdomen and uterus. They're performed when a vaginal delivery is not possible or
safe, or when the health of you or your baby is at risk.

Pre-operative assessment

 Assess the woman about past surgeries, secondary illnesses, allergies to foods or drugs, reaction
to anesthesia, and medications that could increase any surgical risk.
 The woman should be in the best possible physical and psychological state before undergoing
any surgery.
 An obese woman with poor nutritional status is at risk for a slow wound healing.
 Tissue that contains extra fatty cells would be difficult to suture and the incision will heal much
slower and predispose the woman to infection and dehiscence.
 An obese woman would also have difficulty in initiating ambulation and turning after surgery as
it will increase the risk for pneumonia or thrombophlebitis.
 A woman with protein or vitamin deficiency is also at risk for poorer healing because these are
needed for new cell formation at the incision site.
 Age can also affect surgical risk because it can cause decreased circulatory and renal function.
 A woman who has secondary illness is also at greater surgical risk depending on the extent of
the disease because the secondary illness may affect the woman’s ability to adapt to the
demands of the surgery.
 The general medication history of the woman must also be assessed because there are drugs
that could increase the surgical risk by interfering with the effects of anesthesia.
 A woman with lower than normal blood volume might feel the effects of surgery more than a
woman with normal blood volume.
 An example of this is a woman who began labor and was told later on that she should undergo
cesarean birth instead because she may not have had anything to eat or drink for almost 24
hours.
 To prevent fluid and electrolyte imbalance, intravenous fluid replacement is initiated
preoperatively and postoperatively.
 There are women who are very worried about the procedure, so they need a very detailed
explanation of the procedure before they can enter surgery without intense fear.
 A woman who is frightened is at greater risk for cardiac arrest during anesthesia administration.
 Acknowledge that the woman’s fear of surgery is normal so that she can view her feelings as
expected which could increase her self-esteem.

Procedure details

 Using the appropriate incisions, consistent with the estimated size of the fetus, the abdomen is
opened, the rectus muscle are separated, and the peritoneum incised (similar to an abdominal
hysterectomy), exposing the distended uterus.
  Large vessels are clamped or cauterized, but usually no attempt to control hemostasis is made
since it may delay delivery time ( 3-5 minutes after initial incision is ideal).
 The scrub person must be ready with suction, drypostpartum care be an ongoing process rather
than just a single visit after your delivery. Contact your health care provider within the first 3
weeks after delivery. Within six to 12 weeks after delivery, see your health care provider for a
comprehensive postpartum evaluation.
 During this appointment, your health care provider will check your mood and emotional well-
being, discuss contraception and timing of future pregnancies and review information about
infant care and feeding. Your provider also will talk about your sleep habits and issues related to
fatigue, and do a physical exam. This might include checking your abdomen, vagina, cervix and
uterus to make sure you're healing well. In some cases, you might have the checkup earlier so
that your health care provider can examine your C-section incision. Use this visit to ask
questions about your recovery and caring for your baby. laps, and a bulb syringe.
 The bladder is retracted downward with the bladder blade of the balfour retractor and a small
incision is made with the second knife and extended with a bandage scissors (blunt tip prevents
injury to the baby’s head).
 The amniotic sac is entered and immediately aspirated the fluid.
 The bladder blade is removed, and the assistant will push on the patient’s upper abdomen while
the surgeon simultaneously delivers the infant’s head in an upward position.
 The baby’s airways are suctioned with the bulb syringe, and the baby is completely delivered
and placed upon the mother’s abdomen.
 The umbilical cord is double clamped and cut.
 The baby is wrapped in a sterile receiving blanket and transferred to the warming unit for
immediate assessment and care.
 Once the bay has been safely delivered, the emergent phase of the procedure has been ended.
 Using a nonecrushing clamp, the uterine wall is grasped for traction during closure.
 The closure is performed in two layers with a heavy absorbable suture, using a continuous
stitch, the second overlapping the first.
 Following closure of the uterus, the bladder flap is reperitonealized with a running suture, and
the uterus is pushed back inside the pelvic cavity.
 The cavity is irrigated with warm saline, and closed in layers.
 Skin is closed with the surgeon’s preference. If a tubal ligation is to be performed, it is done
prior to the abdominal closure sequence.

Intraop findings

complication + management

Infection -

Postpartum hemorrhage -

Deep Vein Thrombosis -

Post-op care

 After surgery is completed, the mother will be monitored in a recovery area. Pain medication is
given, initially through the IV line, and later with oral medications.
 When the effects of anesthesia have worn off, generally within one to three hours after surgery,
the mother is transferred to a postpartum room and encouraged to move around and begin to
drink fluids and eat food.
 Breastfeeding can usually begin any time after the birth. A pediatrician will examine the baby
within the first 24 hours of the delivery. Most women are able to go home within a few days
after giving birth.
 The abdominal incision will heal over the next few weeks. During this time, there may be mild
cramping, light bleeding or vaginal discharge, incisional pain, and numbness in the skin around
the incision site. Most women will feel well by six weeks postpartum, but numbness around the
incision and occasional aches and pains can last for several months.
 After going home, the woman should notify the health care provider if she develops a fever
(temperature greater than 38°C, if pain or bleeding worsens, or if there are other concerns (eg,
severe headache, abdominal pain, difficulty breathing).

Pathology (small only)

Follow up

 For women who underwent a cesarean section, the first follow-up visit should be two weeks
after delivery. At this appointment, the incision scar will be checked and steri-strips will be
removed if they have not yet fallen out on their own. Another appointment will be scheduled
for the standard six-week postpartum exam.
 Women should call their doctor immediately if any of the following symptoms occur prior to
their scheduled follow-up appointment:
 Signs of mastitis (breast infection), including reddened, hard or tender areas of the breast
accompanied by a fever, excessive vaginal bleeding, abnormally tender abdomen accompanied
by a fever, any opening of a cesarean section incision. Drainage coming from a cesarean section
incision.
 Postpartum care is an ongoing process rather than just a single visit after your delivery. Contact
your health care provider within the first 3 weeks after delivery. Within six to 12 weeks after
delivery, see your health care provider for a comprehensive postpartum evaluation.
 During this appointment, health care provider will check themood and emotional well-being,
discuss contraception and timing of future pregnancies and review information about infant
care and feeding. Your provider also will talk about your sleep habits and issues related to
fatigue, and do a physical exam. This might include checking your abdomen, vagina, cervix and
uterus to make sure you're healing well. In some cases, you might have the checkup earlier so
that your health care provider can examine your C-section incision. Use this visit to ask
questions about your recovery and caring for your baby.

Prognosis
Nursing consideration

Summary

 A caesarean section is a surgical procedure in which a baby is born through a cut made in the
mother’s abdominal wall and uterus.
 A baby will need to be born by caesarean section if there are serious problems that prevent the
baby being born by a normal vaginal birth.
 Caesarean section is a relatively safe operation; however, possible complications include
infection, damage to your internal organs, an increased risk of respiratory distress for your baby
and complications with future pregnancies.