Cesarean Birth Definition An operative procedure to deliver

Cesarean Birth

• Definition • An operative procedure to deliver a viable fetus through an abdominal and uterine incisions. *(American congress for obstetrics and gynecologist)

Indication for Cesarean Birth Cesarean birth is indicated in the following conditions: 1. 2. 3. 4. 5. 6. Previous cesarean birth Fetal distress Uncontrollable third-trimester bleeding Placenta previa Abruptio placentae Fetopelvic disproportion

7. Fetal mal presentation 8. Prolapsed cord 9. Medical complications of pregnancy, such as maternal heart disorder 10. Failure of labor to progress 11. History of herpes simplex virus infection 12. Diabetes mellitus.

Types of Cesarean Birth There are three types of cesarean births: A. Classic Cesarean Birth

B. Transverse Incision: This is the most common type of cesarean birth, where a transverse incision is made in the lower segment of the uterus.

• Advantage: The advantages of a transverse lower segment incision are easier repair, less blood loss, lower incidence of infection, and less risk of subsequent rupture. • Disadvantage: These are that it takes more time and requires more surgical skills.

C. The extraperitoneal cesarean birth: Is less frequently seen and it requires great surgical skills to avoid nicking the bladder

Preoperative Care The preoperative nursing care includes: 1. All the usual procedures for preparing a patient for surgery. 2. The abdominal skin is prepared. 3. A Foley catheter is inserted into the bladder to ensure that it is empty. 4. Elastic stockings are often put on the woman’s leg to reduce peripheral blood pooling and hypotension.

5. The fetal heart rate is recorded with electronic monitoring until the infant is delivered.

Preoperative Phase • Begins with decision to proceed with surgical intervention • Baseline evaluation • Preparatory education

Intraoperative Phase • Begins when patient is transferred to operating room table • Provide for patient safety • Maintain aseptic environment • Provide surgeon with supplies and instruments • Documentation

Postoperative Phase • Admission to recovery room • Maintain airway • Monitor vital signs • Assess effects of anesthesia • Assess for complications of surgery • Provide comfort and pain relief • Ends with follow-up evaluation in clinical setting or home

Preoperative Nursing Management: Patient Education: * Teaching deep breathing and coughing exercises. * Encouraging mobility and active body movement. e. g Turning(change position), foot and leg exercise. * Explaining pain management. * Teaching cognitive coping strategies.

Preoperative Nursing Management: Managing nutrition and fluids. − The major purpose of withholding food and fluid before surgery is to prevent aspiration. − A fasting period of 8 hours or more is recommended for a meal that includes fried or fatty foods or meat * Preparing the bowel for surgery. − Enema is not commonly ordered, unless the patient is undergoing abdomen or pelvic surgery * Preparing the skin. −The goal of preoperative skin preparation is to decrease bacteria without injury to the skin. .

Immediate preoperative nursing intervention: * Administering preanesthetic medication. * Maintaining the preoperative record. e. g. Final checklist, consent form, identification.

Nursing management in the post anesthesia care unit: I-Assessing the patient: Frequent assessment of the patient oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color , depth of consciousness.

II- Maintaining a patent airway: − The primary objectives are to maintain pulmonary ventilation and prevent hypoxia and hypercapenia. − The nurse applies oxygen, and assesses respiratory rate and depth, oxygen saturation

Nursing management in the post anesthesia care unit: III- Maintaining cardiovascular stability: − The nurse assesses the patient’s mental. GCS sacle status, vital signs, cardiac rhythm, skin temperature, color and urine output. − Central venous pressure, arterial lines and pulmonary artery pressure. − The primary cardiovascular complications include hypotension, shock, hemorrhage, hypertension and dysarrythmias.

IV- Relieving pain and anxiety: − Opioid analgesic. V- Assessing and managing the surgical site: − The surgical site is observed for bleeding, type and integrity of dressing and drains. VI- Assessing and managing gastrointestinal function: − Nausea and vomiting are common after anesthesia. − Check of peristalsis movement.

VII- Assessing and managing voluntary voiding: − Urine retention after surgery can occur for a verity of reasons. Opioids and anesthesia interfere with the perception of bladder fullness. - Abdominal, pelvic , hip may increase the like hood of retention secondary to pain.

• VIII- Encourage activity: • − Most surgical are encouraged to be out of bed as soon as • possible. Early ambulation reduces the incidence of post • operative complication as , atelectasis , pneumonia, • gastrointestinal discomfort and circulatory problem

Post Operative Complication: 1 - Shock: Is the response of the body to a decrease in the circulating volume of blood, tissue perfusion impaired, cellular hypoxia and death. 2 - Hemorrhage: Is the escape of blood from a blood vessel. 3 - Deep vein thrombosis. (DVT). Occur in pelvic vein or in lower extremities.

Post Operative Complication: 4 - Pulmonary embolism. It’s the obstruction of one or more pulmonary arterioles by an embolus originating some where in the venous system or in the right side of heart. 5 - Urinary Retention. 6 - Intestinal obstruction. Result in partial or complete impairment to the forward flow of intestinal content.

Potential Intraoperative complication: • Nausea and vomiting • Anaphylaxis • Hypoxia and other respiratory complication • Hypothermia

Postpartum Care Nursing assessment in this immediate post birth period includes: • Degree of recovery from anesthetic effects. • Postoperative and post birth status and degree of pain. • A patent airway is maintained, and the woman is positioned to perform possible aspiration. • Vital signs are taken every 15 minutes for 1 to 2 hours, or until the woman is stable.

• The condition of the incisional dressing, the fundus, and amount of lochia are assessed, as well as intake and out. • Deep breathing and leg exercise. • Medication for pain maybe administered. Physiologic concerns the first few days maybe dominated by pain at the incision site and from the intestinal gas the need for pain relief. . Ensure proper application and fit of elastic stockings, stocking is to reduce peripheral blood stasis and hypotension.

Pain medication usually is ordered every 3 to 4 hours. Lately care includes perineal care, breast care, and routine vaginal care, including showering after the dress been removed. During each shift the nurse should check the vital signs, the incision, fundus, and lochia. Sounds, bowel sounds, Homan’s sign, and urinary elimination.

Discharge Teaching Discharge teaching includes information about: 1. 2. 3. 4. 5. 6. 7. Diet Exercise Activity restriction Breast care Sexual activity Contraception Medications

8. Signs of complications 9. Abdominal binder

• Signs of postoperative complications after discharge: The following signs should be reported to the health care provider: 1. Fever greater than 100. 4˚ (38˚C) 2. Painful urination 3. Lochia heavier than a normal menstrual period 4. Wound separation 5. Redness or oozing at the incision site 6. Severe abdominal pain