Cesarean Section ● Obstructive Mass in Genital Tract

(C-Section, Cesarean Birth) ● Permanent Cervclage

Definition Fetal Indications for C-Section

is the surgical delivery of the through a cut
(incision) made in the mother’s abdomen ● Nonreassuring Fetal Status
and uterus. It is typically performed when (Abnormal umbilical cord on Doppler
vaginal birth poses risks to the mother or study) or Abnormal fetal heart
baby or when complications arise during tracing
labor. The surgery typically takes between ● Umbilical cord prolapse
30 to 60 minutes or longer depending on the ● Malpresentation
circumstances. In some cases such as ● Macrosomia
emergency c-section, the baby can be ● Congenital anomaly
delivered in as little as 15 minutes. ● Thrombocytopenia
● Prior Neonatal Birth Trauma
S/sx and Indications
Common Indications for a C-Sections are:
Maternal Indications for C-section
● Fetal Distress
● Abnormal Positioning of the Baby
● Prior Cesarean Delivery
● Placental Issues
● Maternal Request
● Previous Cesarean Delivery
● Pelvic Deformity (Cephalopelvic
● Multiple Gestation
disproportion)
● Size of the Baby
● Previous Perineal Trauma
● Active herpes sore in the mother’s
● Prior pelvic or anal/rectal
vagina
reconstructive surgery
● Problems with Labor
● Herpes Simplex
● Cardiac or Pulmonary Disease
● Cerebral Aneurysm Laboratory and Diagnostic Tests
● Pathology requiring concurrent
intraabdominal surgery Ultrasound/Ultrasonography
● Perimortem Cesarean - Used to determine the number of
fetuses, fetal circulation, fetal
Uterine/Anatomic Indications for C-Section anatomy, the amount of amniotic
fluid and estimate the fetal weight.
● Abnormal Placentation (eg Placenta
Previa, Placenta Accreta) Cardiotocography
● Placental Abruption - Used to Monitor fetal heart rate and
● Prior Classical Hysterotomy detect fetal distress.
● Prior full-thickness myomectomy
● History of uterine incision Blood Tests
dehiscence - Used to detrmine blood type,
● Invasive Cervicsal Cancer hemoglobin levels, and other blood
● Prior Trachelectomy components.
 Incisions
Electrocardiography
- Monitors the mother’s cardiovascular
The incision made in the skin may be:
condition

Other preoperative examinations: A Lower Segment Incision

● Screening tests for HIV, HepaB, - This is a Horizontal (Across) cut
Syphilis through the abdomen and a
Horizontal cut through the lower part
of the uterus.
Anesthesia - ‘Bikini Line’ Incision
- These cuts heal better and are less
likely to cause problems in future
Spinal Anaesthetic pregnancies.
- The most common anasthetic for a
planned cesarean. A Classical Incision
- A needle will be inserted between - Refers to a vertical cut on the uterus.
the bones in your spine and local - This type of incision is usually only
anaesthetic will be injected through used for extreme emergencies of in
the needle. sepcific situations such as:
- This will block the pain from your 1. Placenta is lying very low
chest downwards 2. The baby is lying sideways
3. The baby is very small
Epidural Anaesthetic - It can increase the chance of having
- Often used to lessen the pain of problems in later pregnancies and
labour. births.
- A plastic tube that will be inserted
into a space around the lining of the
Procedural Steps
spine, local anaethetic will be
injected through the tube.
- Pain sensation will be blocked from Procedures may vary depending on your
your waist down. condition and your helthcare provider’s
practice. In most cases, the patient will be
General Anaesthetic awake for a C-Section.
- May be given if the baby needs to be
born quickly. 1.The patient will be changed into a
- The mother will breath oxygen operating gown.
through a mask and will be given
medicine through a drip, which will 2.The patient will be positioned on an
operating table.
make the mother drowsy then be put
to sleep. 3.A urinary catheter may be put in if it was
- The mother will be asleep not done before coming to the operating
throughout the surgery. room.

4.An IV line will be started in the clients

arm. (If Needed) 17.They will the close the skin incision
with stitches or surgical staples.
5.For safety reason, straps will be placed
over the clients arms or legs to hold her 18.Finally, the surgeon will apply a sterile
down. bandage.

6.Hair around the surgical site may be

shaved. The skin will be cleaned with Instruments
antiseptic solution.

7.The abdomen will be draped with sterile 1. Backhaus Towel Clamps - Are
materials. A drape will be also placed mainly used to fasten drapes or
above the clients chest to screen the towels to patients durign medical
surgical site. procedures in order for them to stay
on.
8.The anesthesiologist will continously
watch the heart rate, bp, breathing, and 2. Outlet Forceps - Used when the
blood oxygen level during the procedure. baby’s head is at the end of the birth
canal and is visible.
9.Once the anesthesia has taken effect, 3. Artery Forcep - For controlling
the surgeon will make an incision site bleeding and for the retraction of
above the pubic bone, either transverse
tissues, skins, etc.
or vertical. Sounds of an electrocautery
machine might be heard. 4. Green Armytage Forceps - Used to
hold the incised uterine edges.
10.The surgeon will make deeper 5. Sponge Holding Forceps - Used to
incisions through the tissues and separate hold sponges.
the muscles until uterine wall is reached. 6. Allis Tissue Forceps - Used to hold
They will then make a final incision in the
or grap heavy tissue.
uterus (vertical or horizontal).
7. Littlewood Tissue Forceps - Used
11.The surgeon will open the amniotic sac for grasping slippery tissues.
and deliver the baby through the opening. 8. Scalpel Handles 4 - Used for skin
incision.
12.The umbilical cord will then be cut.
9. Needle Holders - Helps maneuvre
13.Medicine will be adminestered through the needle through various tissues.
IV to help uterus contract and expel the 10. Doyen Retractors - Used for
placenta. retracting the bladder away from the
incision site on the uterus and
14.The surgeon will then remove the
gaurding it against potential injury
placenta and examine the uterus for tears
or pieces of placenta. when suturing.
11. Laugenbeck Retractors - Used to
15.The surgeon will then use stitches to retract skin during closure of the
close the incision in the uterine muscle rectus sheath at cesarean section.
and reposition the uterus in the pelvic 12. Mayo Scissors - Used when
cavity.
surgeon needs to cut through tough
16.The surgeon will close the muscle and scar tissue.
tissue layers with sutures. 13. Spencer Ligature Scissor - Are
used for cutting stitches or sutures.
 14. Electrosurgical cautery pencil - in position or straightening of bed
Uses electric current to make an linen.
incision and controls the bleeding. 3. Encourage the woman to ambulate
to relieve gas pain.
Nursing Management 4. Inform the woman the she should
not take acetylsalicylic acid or
aspirin because this can interfere
Intraoperative Nursing Management
with blood clotting and healing
5. Place a pillow on her lap as she
1. Assist the patient to move from
feeds the infant to deflect weight of
transport stretcher to the operating
the infant from the suture line to
table.
lessen pain.
2. Encourage the patient to remain on
6. Caution the woman not to strain to
her side or place a pillow under her
pass stools because this puts
right hip.
pressure on the incision.
3. Continue pulse oximetry monitoring
4. Position the mother with a towel
under her right hip to move
abdominal contents away from the
surgical feild and lift the uterus from
the vena cava.
5. The incision site is scrubbed with
antiseptic, and additional drapes are
placed around the area.

Post-Operative Nursing Management

1. Use a pain rating scale to assess

degree of pain.
2. Supplement the analgesics with
comfort measures such as a change