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

. the first recorded woman surviving a Caesarean section was in the 1580s. 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.HISTORY      Bindusara (born c. the second Mauryan Samrat (emperor) of India. in Siegershausen. 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.272 BC). ruled 298 – c. 320 BC.

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

Critical and Crash)  Planned (Scheduled and Elective)  .TYPES  Type of incision:   Horizontal (lower uterine) Vertical (classical)  Urgency: Emergency (Unplanned.

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. uncontrolled bleeding and very urgent cases. when there is no time to perform a regional anesthesia  . other advantages include the absence of typical risks of general anesthesia: pulmonary aspiration of gastric contents and intubation  General anesthesia: heavy.PROCEDURE  Both general and regional anaesthesia (spinal.

Initial incision and multiple layers of incisions The uterine incision .

Suctioning amniotic fluids Disengaging baby from the pelvis and baby’s head is born  .

Suctioning the Baby Baby’s 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.there should be no strenuous work for up to six months    . 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.

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)  .

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000 live births among women who had C-sections/ 0.RISKS  Mother    Child     Higher mortality rate than in vaginal birth Abdominal surgery risks (postoperative adhesions.62 per 1.77 per 1. 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: 1.000 for women who delivered vaginally .

RESEARCH PAPER .

Professor of Obstetrics and Gynaecology at the University of Dundee .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 women’s 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.

343:120-31 .OXYTOCIN BOLUS VERSUS OXYTOCIN BOLUS AND INFUSION FOR CONTROL OF BLOOD LOSS AT ELECTIVE CAESAREAN SECTION: DOUBLE BLIND. Geary M. Carey M. Montgomery AA. Gleeson R.. ECSSIT Study Group BMJ 2011. RANDOMISED TRIAL Murphy D. PLACEBO CONTROLLED. McAuliffe FM. Eogan M. Sheehan SR.

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 .

  conducted from February 2008 to June 2010 in five maternity hospitals in the Republic of Ireland .9% saline solution over 4 hours (placebo infusion) (bolus only). women receiving anticoagulant treatment. previous major obstetric haemorrhage (>1000 mL). coagulopathies. 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. those who did not understand English.9% saline solution over 4 hours (bolus and infusion)  Placebo group: 5 IU oxytocin bolus over 1 minute and 500 mL of 0. or known fibroids.SAMPLE  AND METHODS 2069 women booked for elective caesarean section at term with a singleton pregnancy  excluded placenta praevia. and those who were younger than 18 years  Double blind. thrombocytopenia.

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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