Cesarean Section

Under supervision :
Assist. Prof / Amal Khalifa
Assist. Prof/ Gamila Gaber
Dr/ Seham Shehata
 ‫منار عبدالخالق عطيه ابوزيد‬ ‫‪44‬‬ ‫محمود ناصر عبدالحميد الجارحي‬ ‫‪1‬‬
‫منار عزت عبدالمقصود رضوان‬ ‫‪44‬‬ ‫محمود ياسر نصرالدين محمود‬ ‫‪2‬‬
‫منار محمد حسانين عبدالله‬ ‫‪44‬‬ ‫محمود ياسين أنور عبدالحكيم‬ ‫‪3‬‬
‫منار محمود إبراهيم عبدالغفار‬ ‫‪44‬‬ ‫مختار محمد مختار عبدالحميد‬ ‫‪4‬‬
‫منار محمود محمود موسي‬ ‫‪44‬‬ ‫مروان احمد مرسي عيسي‬ ‫‪4‬‬
‫منار مسعد محمد المحالوي‬ ‫‪44‬‬ ‫مروه احمد زين سالمان‬ ‫‪4‬‬
‫منه الله إبراهيم احمد الشوني‬ ‫‪45‬‬ ‫مروه ربيع عبدالحفيظ عبدالحفيظ‬ ‫‪4‬‬
‫منه الله احمد إسماعيل الخضرجي‬ ‫‪41‬‬ ‫مروه عبدالفتاح عبدالحميد اسماعيل‬ ‫‪4‬‬
‫منه الله السيد الشحات الليثي‬ ‫‪42‬‬ ‫مروه عوض علي عيسي‬ ‫‪4‬‬
‫منه الله سعيد فتح الله بكر‬ ‫‪43‬‬ ‫مروه مجدي محمد حماد‬ ‫‪15‬‬
‫منه الله عصام احمد شتات‬ ‫‪44‬‬ ‫مروه مرزوق فوزي الشاذلي‬ ‫‪11‬‬
‫منه الله فتحي عبدالرحمن محمد‬ ‫‪44‬‬ ‫مريم عبدالحميد السيد عبدالحميد‬ ‫‪12‬‬
‫منه الله محمود احمد السيسي‬ ‫‪44‬‬ ‫مريم إبراهيم مختار شرابي‬ ‫‪13‬‬
‫منه الله مدحت عبدالمعز محمدي‬ ‫‪44‬‬ ‫مريم اشرف محمد الغرابلي‬ ‫‪14‬‬
‫منه الله ناصر إبراهيم السيد‬ ‫‪44‬‬ ‫مريم ايمن فضل زرزور‬ ‫‪14‬‬
‫منه الله ياسر احمد عبدالرحيم‬ ‫‪44‬‬ ‫مريم جمال عامر شحاته‬ ‫‪14‬‬
‫منه الله ياسر عبدالله محمد‬ ‫‪45‬‬ ‫مريم سعيد احمد جمعه‬ ‫‪14‬‬
‫منه عزمي محمد عبدالحميد‬ ‫‪41‬‬ ‫مريم عادل زكي ميخائيل‬ ‫‪14‬‬
‫منه محمد محمد إسماعيل‬ ‫‪42‬‬ ‫مريم عبدالمنعم محمود علي‬ ‫‪14‬‬
‫مني صالح احمد صباح‬ ‫‪43‬‬ ‫مريم عزت عبدالسميع البيلي‬ ‫‪25‬‬
‫مني عزت عبدالمقصود رضوان‬ ‫‪44‬‬ ‫مريم عماد سامي عبدالقادر‬ ‫‪21‬‬
‫مني فاروق عيسوي شاهين‬ ‫‪44‬‬ ‫مريم كمال إبراهيم بدرالدين‬ ‫‪22‬‬
‫مني ياسر محمد شهاب الدين‬ ‫‪44‬‬ ‫مريم محمد عبدالمعطي المسير‬ ‫‪23‬‬
‫مني محمد إبراهيم سلطان‬ ‫‪44‬‬ ‫مريم محمد عبدالرحيم غنيم‬ ‫‪24‬‬
‫مني هشام السيد حافظ‬ ‫‪44‬‬ ‫مريم ناجي زهران مبروك‬ ‫‪24‬‬
‫مها عادل فتح السيد‬ ‫‪44‬‬ ‫مريم ناصر راغب علي‬ ‫‪24‬‬
‫مها فايز عامر عبدالحليم‬ ‫‪45‬‬ ‫مصطفي إبراهيم مصطفي فايد‬ ‫‪24‬‬
‫مها محمد عبدالعزيز محمد‬ ‫‪41‬‬ ‫مصطفي احمد مسعود ابراهيم‬ ‫‪24‬‬
‫مهاب بشير عبدالرازق عرفه‬ ‫‪42‬‬ ‫مصطفي السيد مصطفي مجاهد‬ ‫‪24‬‬
‫موده محمد احمد هشهش‬ ‫‪43‬‬ ‫مصطفي جمال عبدالحليم نجم‬ ‫‪35‬‬
‫مورا ميخائيل رزق حنا‬ ‫‪44‬‬ ‫مصطفي طاهر صابر عوض شاهين‬ ‫‪31‬‬
‫مؤمن عبدالحكيم عبدالحميد بقوش‬ ‫‪44‬‬ ‫مصطفي عبدالقادر محمد ابوسالم‬ ‫‪32‬‬
‫مي ايمن يوسف الخولي‬ ‫‪44‬‬ ‫مصطفي محمد مصطفي التراس‬ ‫‪33‬‬
‫مي عبدالنبي محمد سليمان‬ ‫‪44‬‬ ‫مصطفي معتمد رضا عبدالغني‬ ‫‪34‬‬
‫مي محمد عبدالسالم السقا‬ ‫‪44‬‬ ‫مصطفي عصام مصطفي الشربيني‬ ‫‪34‬‬
‫مي مصطفي عبدالعظيم خالد‬ ‫‪44‬‬ ‫مصطفي فتحي محمد عبداللطيف‬ ‫‪34‬‬
‫مي منجد إبراهيم ابوعلي‬ ‫‪45‬‬ ‫معتز السيد محمد يوسف‬ ‫‪34‬‬
‫مياده عادل محمود رمضان‬ ‫‪41‬‬ ‫منار توفيق احمد محفوظ‬ ‫‪34‬‬
‫مياده ماهر رزق سليمان‬ ‫‪42‬‬ ‫منار خالد محمد حسن‬ ‫‪34‬‬
‫ميرنا عوض الله عطيه عوض الله‬ ‫‪43‬‬ ‫منار رجب محمد علي‬ ‫‪45‬‬
‫نادر السيد عادل السيد‬ ‫‪44‬‬ ‫منار رفعت رزق العربي‬ ‫‪41‬‬
‫نادية إيهاب عبدالصادق إسماعيل‬ ‫‪44‬‬ ‫منار صالح رمضان عبدالمقصود‬ ‫‪42‬‬
‫نادية سمير احمد محمد‬ ‫‪44‬‬ ‫منار عاطف سعيد الدسوقي‬ ‫‪43‬‬
‫نانسي كمال احمد تمراز‬ ‫‪44‬‬
 Out lines :
1- Introduction
2- Definition
3- Types
4- Risk factor
5- Indication
6- Contraindication
7- Complication
8- Preparation of cesearean section
9- Nursing management
10- Reference
Introduction
The anatomy and physiology of uterus

Anatomy of uterus :

The uterus or womb is a pear shaped organ that is found in the

pelvis at the top of the vagina. The uterus in a woman that is not
pregnant does not extend above the pubic bone

The physiology:

To achieve a cesarean delivery, the surgeon must traverse all the

layers that separate him/her from the fetus.

*First, the skin is incised, followed by the subcutaneous tissues.

The next layer is the fascia overlying the rectus abdominis muscles.

*After separating the rectus muscles the surgeon enters the

abdominal cavity through the parietal peritoneum.

*The uterus is next incised. It consists of the serosal outer layer

(perimetrium), the muscle layer (myometrium), and the inside
mucosal layer (endometrium). All three of these layers are incised
to make the uterine incision.

*Depending on the status of the patient’s amniotic membranes (if

her “water is broken” or intact), the surgeon could encounter that
amniotic sac upon incision of the uterus. The amniotic sac, if
present, would be the last layer between the surgeon and the fetus.

*this point the fetus is delivered, achieving the primary goal of the
cesarean section
Definition:-
Caesarean section, also known as C-section or caesarean delivery, is the
surgical procedure by which one or more babies are delivered through an
incision in the mother’s abdomen After viability of the fetus , often
performed because vaginal delivery would put the baby or mother at risk
 - Types :-
*There are many types of caesrean section*
*1/ The classic caesrean section:-*
A midline longtudinal (verticle) incision , made in upper segment

of utreus .

*advantages*

- large space to deliver the baby .

- Fetus can deliver easily, quickly and safely with minimal risk .
-

*disadvantages*
• -the mother don’t have chance of vaginal birth for the next time .
• due to increase vascularity may cause hematoma formation , So
healing is reduced .
• -visceral peritonim may adhere to upper uterine ,So more liable to
many complications like intestinal adhesion . So classic section not
preferred method

*2/lower segment caesrean section*

*Advantages* :-
1- cause fewer problems in later pregnancies , because it makes a
stronger scar reducing the chance of uterine rupture.
2- lesser bleeding due to lesser vascularity.
 3- Apposition better.
4- less active uterine segment.
5- Transverse incision is made in the lower segment ,this heals faster and
successfully than an incision in the upper segment of the uterus.
*Disadvantages*:-
1- The likelihood of extension cephalad into the uterine fundus or
caudally into the bladder, cervix or vagina.
*There are other types of cesarean section that less happened :-*
1- Emergency C Section: When there is suspected danger to the mother’s
or baby’s condition an emergency section is resorted to.
2- Elective Cesarean Section (Planned C-Section): The Cesarean is
planned and done on a specific date chosen by the patient and the
doctor after assessing the maturity of the baby.

Risk factors
 obesity
 large infant size
 emergency complications that necessitate a cesarean
 delivery
 long labor or surgery
 having more than one baby
 allergies to anesthetics, drugs, or latex
 Maternal inactivity
 low maternal blood cell count
 use of an epidural
 premature labor
 diabetes
Indication :-
-Maternal Indications for Cesarean
• Prior cesarean delivery
• Maternal request
• Pelvic deformity or cephalopelvic disproportion
• Previous perineal trauma
• Prior pelvic or anal/rectal reconstructive surgery
• Herpes simplex or HIV infection
• Cardiac or pulmonary disease
• Cerebral aneurysm or arteriovenous malformation
• Pathology requiring concurrent intraabdominal surgery
• Perimortem cesarean
Uterine/Anatomic Indications for Cesarean
• Abnormal placentation (such as placenta Previa, placenta accrete)
• Placental abruption
• Prior classical hysterotomy
• Prior full-thickness myomectomy
• History of uterine incision dehiscence
• Invasive cervical cancer
• Prior trachelectomy
• Genital tract obstructive mass
• Permanent cerclage
Fetal Indications for Cesarean
• Nonreassuring fetal status (such as abnormal umbilical cord Doppler
study) or abnormal fetal heart tracing
 • Umbilical cord prolapse
• Failed operative vaginal delivery
• Malpresentation
• Macrosomia
• Congenital anomaly
• Thrombocytopenia
• Prior neonatal birth trauma

Contraindication
1) When maternal status may be compromised (eg, mother has
severe pulmonary disease)

2) If the fetus has a known karyotypic abnormality or known congenital

anomaly that may lead to death (anencephaly)

3) Dead fetus expect in :

 extreme degree of pelvic contraction

 Neglected shoulder
 Sever accidental hemorrhage

4) Disseminated intravascular coagulation to minimize blood loss

5) extensive scar or pyogenic infection in the abdominal wall e.g in

burns
Complications
Complications to babies include:

 Breathing problems. Babies born by scheduled C-section are

more likely to develop a breathing issue that causes them to
breathe too fast for a few days after birth (transient tachypnea).
 Surgical injury. Although rare, accidental nicks to the baby's
skin can occur during surgery.
Complicatios to mothers include:

 Infection: After a C-section, there might be a risk of developing

an infection of the lining of the uterus (endometritis), in the urinary
tract or at the site of the incision.
 Blood loss: A C-section might cause heavy bleeding during and
after delivery.
 Reactions to anesthesia: Reactions to any type of anesthesia
are possible.
 Blood clots: A C-section might increase the risk of developing a
blood clot inside a deep vein, especially in the legs or pelvis (deep
vein thrombosis). If a blood clot travels to the lungs and blocks
blood flow (pulmonary embolism), the damage can be life-
threatening.
 Surgical injury: Although rare, surgical injuries to the bladder or
bowel can occur during a C-section.
 Increased risks during future pregnancies: Having a C-section
increases the risk of complications in a later pregnancy and in
other surgeries. The more C-sections, the higher the risks of
placenta previa and a condition in which the placenta becomes
attached to the wall of the uterus (placenta accreta).
 A C-section also increases the risk of the uterus tearing
along the scar line (uterine rupture) for women who attempt a
vaginal delivery in a later pregnancy.

Preparation pre cesarean section:-

In the weeks before

o Talk with your doctor about your birth control plan o Sign
consents for surgery o Eat a healthy, balanced diet
o Choose your pediatrician (doctor for your new baby)
Showers before your C-section
Your nurse will give you a packet with 2 chlorhexidine gluconate (CHG)
cloths
Shower #1: Night Before Surgery
o Use your regular soap (such as Dial). Clean your body well. Do not
shave any area of your body that is near the surgical site. Dry off with a
clean towel.
o Then, use one of the CHG cloths to wipe the front of your body. Wipe
from below your breasts, over your abdomen, and down to your upper
thighs. Do not wipe your genital area
 o Allow your skin to air dry. Dress in clean bedclothes.
Shower #2: Morning of Surgery
o Shower again with regular soap. Do not shave any area of your body that is
near the surgical site.
Dry off with a clean towel
o Then, use the 2nd CHG cloth to wipe the front of your body, the same
as you did last night
o Allow your skin to air dry. Do not apply hair products deodorants,
lotions, or fragrances.
o Dress in clean clothes and come to the hospital as planned.
Eating before

o You may eat and drink as usual until 8 hours before

your C-section.
o 8 hours before your C-section, drink 8 ounces of
apple juice.
 o Keep drinking clear liquids until 2 hours before your
C-section.
o 2 hours before your C-section, drink 8 ounces of
apple juice.
o Starting 2 hours before your C-section, do not take
anything by mouth.
Stop medicine
Ask your doctor to review all the medicines you are taking. You may need to
stop taking some of them for a few days or longer before your C-section
Labor and delivery

In Labor and Delivery, you will:

o Sign consent forms for surgery if not already done
o Meet with the anesthesia team Meet with the delivery
team A nurse will:
o Place an intravenous (IV) line in your arm o Draw
blood so we can check your blood sugar o Clip your
pubic hair
o Start a fetal heart rate monitor so we can check your
baby’s heart rate
Before surgery
In the OR:
o You will drink an antacid drink. o The anesthesia team
will give you spinal anesthesia or place an epidural. o
You will start to feel numb from your breasts to your
toes.
A nurse will:
o Place wraps (SCDs) on your legs to prevent blood clots
Wash your abdomen o Place a Foley catheter in your
bladder to drain urine
Preparation intra cesarean section :-
 You will drink an antacid drink.
 The anesthesia team will give you spinal anesthesia or place an epidural.
 You will start to feel numb from your breasts to your toes.
 Anurse willPlace wraps (SCDs) on your legs to prevent blood clots Wash
your abdomen
 Place a Foley catheter in your bladder to drain urine

Generally, a C-section follows this process:

1- You will be asked to undress and put on a hospital gown.
2- You will be positioned on an operating or exam table.
3- A urinary catheter may be put in if it was not done before coming to
the operating room.
4- An intravenous (IV) line will be started in your arm or hand.
5- For safety reasons, straps will be placed over your legs to hold you on
the table.
6- Support and assist in positioning the patient during insertion of
spinal/epidural an aesthetic.
7- Hair around the surgical site may be shaved. The skin will be cleaned
with an antiseptic solution.
8- Your abdomen (belly) will be draped with sterile material. A drape will
also be placed above your chest to screen the surgical site.
9- The anesthesiologist will continuously watch your heart rate, blood
pressure, breathing, and blood oxygen level during the procedure.
10- Once the anesthesia has taken effect, your provider will make an
incision above the pubic bone, either transverse or vertical. You may
hear the sounds of an electrocautery machine that seals off bleeding.
11- Your provider will make deeper incisions through the tissues and
separate the muscles until the uterine wall is reached. He or she will
make a final incision in the uterus. This incision is also either horizontal
or vertical.
12- Your provider will open the amniotic sac, and deliver the baby through
the opening. You may feel some pressure or a pulling sensation.
13- He or she will cut the umbilical cord.

14- You will get medicine to help the uterus contract and expel the
placenta in your IV.
15- Your provider will remove your placenta and examine the uterus for
tears or pieces of placenta.
16- He or she will use sutures to close the incision in the uterine muscle
and reposition the uterus in the pelvic cavity.
17- Your provider will close the muscle and tissue layers with sutures. He
or she will close the skin incision with sutures or surgical staples.
 18- Finally, your provider will apply a sterile bandage.
Preparation post cesarean section

Postpartum Care:-
• The Postpartal care period of a woman who has undergone emergent
cesarean birth is divided into two: immediate recovery period and
extended Postpartal period.
• After surgery, the woman would be transferred by stretcher to the post
anesthesia care unit.
• If spinal anesthesia was used, the woman’s legs are fully anesthetized so
she cannot move them.
• Pain control is a major problem after birth because it was so intense that
it interfered with the woman’s ability to move and deep breathe.
• This may lead to complications such as pneumonia or thrombophlebitis.
• Use a pain rating scale to allow a woman to rate her pain.
• Some women may need patient-controlled analgesia or continued
epidural injections to relieve the pain.
• Supplement the analgesics with comfort measures such as a change in
position or straightening of bed linen.
• Instruct the woman to ambulate because this is the most effective
method to relieve gas pain.
• Inform the woman that she should not take acetylsalicylic acid or aspirin
because this can interfere with blood clotting and healing.
• Instruct the woman to place a pillow on her lap as she feeds the infant
to deflect the weight of the infant from the suture line and lessen the pain.
• Football hold for breastfeeding is a way to keep the infant’s weight off
the mother’s incision.
• During the extended Postpartal period, the woman most commonly
experiences gastrointestinal function interference.
• Note carefully the woman’s first bowel movement after surgery because if
no bowel movement has been observed, the physician may order a stool
softener, a suppository, or an enema to facilitate stool evacuation.
• Teach the woman to eat a diet high in roughage and fluid and to attempt
to move her bowels at least every other day to avoid constipation.
• Incisional pain may interfere with the woman’s ability to use her
abdominal muscles effectively, so the physician may prescribe a stool
softener.
• Caution the woman not to strain to pass stools because this puts pressure
on their incision.
• Advise the woman to keep their water pitcher full as a reminder for her to
drink fluids.
• Reassure the woman that it is normal not to have bowel movements for 3
to 4 days postoperatively, especially if there is enema administered before
surgery.
 Nursing management :-
Nursing management of Cesarean section involves the comprehensive care
and support provided to women undergoing a surgical delivery. Here is an
overview of the important aspects of nursing management during the
Cesarean section process:
Preoperative Care:

• Assess and document the woman’s medical history, including any allergies
or chronic conditions.
• Ensure the woman has provided informed consent for the procedure.

• Administer preoperative medications as prescribed (e.g., prophylactic

antibiotics, antacids).
• Establish intravenous (IV) access and initiate hydration if necessary.
• Educate the woman about the procedure, including the rationale, potential
risks, and expected outcomes.
• Offer emotional support and address any concerns or anxieties
.
Intraoperative Care:

• Assist the woman in positioning for the surgery, ensuring proper alignment
and comfort.
• Prepare the surgical site by performing a thorough sterile scrub and draping.
 • Collaborate with the surgical team to ensure aseptic technique is
maintained throughout the procedure.
• Monitor vital signs, including blood pressure, heart rate, and oxygen
saturation.
• Provide emotional support and reassurance to the woman during the
surgical process.
• Document the events and interventions during the surgery accurately.

Postoperative Care:

• Monitor the woman’s vital signs frequently, including blood pressure,

heart rate, respiratory rate, and oxygen saturation.
• Assess the woman’s level of consciousness and pain regularly.
• Observe the surgical incision site for signs of infection, hematoma, or
dehiscence.
• Administer prescribed medications, such as analgesics and antiemetics, as
needed.
• Encourage early ambulation to prevent complications like
thromboembolism and promote bowel function.
• Assist with breastfeeding initiation and provide lactation support, if
desired by the woman.
• Educate the woman about self-care, including wound care, pain
management, and signs of complications.
• Provide emotional support and address any concerns or fears the woman
may have.
 • Collaborate with the multidisciplinary team to facilitate the woman’s
discharge planning

Complation Management:
• Recognize and respond promptly to signs of postoperative
complications, such as infection, hemorrhage, or thromboembolism.
• Administer prescribed medications, such as antibiotics or
anticoagulants, as ordered.
• Monitor and manage pain effectively using pharmacological and non-
pharmacological interventions.
• Collaborate with the healthcare team to provide additional
interventions, such as wound care or drain management.

-It’s important for nurses to have a thorough understanding of Cesarean

section procedures, complications, and evidence-based practices to
provide safe and effective care to women undergoing this surgical
intervention. Nursing management should focus on promoting maternal
and neonatal wellbeing, ensuring the woman’s comfort, and facilitating a
smooth recovery process.
 Referance
& World Health Organization (WHO) 2023 Cesarean section available at
https://www.healthline.com/health/pregnancy/complications-cesarean-
section#risk-factors

& National Library Of Medicine (NCBI) 2023 Cesarean section available

atCesarean Section - StatPearls - NCBI Bookshelf (nih.gov)

& American Heart Association. (2006). Handbook of Emergency Cardiac

Care (p. 57). Salem, MA: AHA.