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    Cesarean Section (C-Section)

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    Andreychi Kalaba
    The document discusses Cesarean section (C-section). It provides background on the history and types of C-sections. It describes the typical procedure, recovery process, common indications like fetal distress or breech presentation, and risks to both mother and child like increased mortality. It then discusses a research study led by Professor Deirdre Murphy on using oxytocin bolus versus bolus and infusion to control blood loss during elective C-sections. The randomized controlled trial found adding an oxytocin infusion reduced the need for extra uterotonic agents but did not overall affect major obstetric hemorrhaging.

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    Cesarean Section (C-Section)

    Uploaded by

    Andreychi Kalaba
    269 views23 pages
    The document discusses Cesarean section (C-section). It provides background on the history and types of C-sections. It describes the typical procedure, recovery process, common indications like fetal distress or breech presentation, and risks to both mother and child like increased mortality. It then discusses a research study led by Professor Deirdre Murphy on using oxytocin bolus versus bolus and infusion to control blood loss during elective C-sections. The randomized controlled trial found adding an oxytocin infusion reduced the need for extra uterotonic agents but did not overall affect major obstetric hemorrhaging.

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    Cesarean Section (C-section)

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    The document discusses Cesarean section (C-section). It provides background on the history and types of C-sections. It describes the typical procedure, recovery process, common indications like fetal distress or breech presentation, and risks to both mother and child like increased mortality. It then discusses a research study led by Professor Deirdre Murphy on using oxytocin bolus versus bolus and infusion to control blood loss during elective C-sections. The randomized controlled trial found adding an oxytocin infusion reduced the need for extra uterotonic agents but did not overall affect major obstetric hemorrhaging.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    269 views23 pages

    Cesarean Section (C-Section)

    Uploaded by

    Andreychi Kalaba
    The document discusses Cesarean section (C-section). It provides background on the history and types of C-sections. It describes the typical procedure, recovery process, common indications like fetal distress or breech presentation, and risks to both mother and child like increased mortality. It then discusses a research study led by Professor Deirdre Murphy on using oxytocin bolus versus bolus and infusion to control blood loss during elective C-sections. The randomized controlled trial found adding an oxytocin infusion reduced the need for extra uterotonic agents but did not overall affect major obstetric hemorrhaging.

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    Download as PPT, PDF, TXT or read online from Scribd
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    of 23

    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

    HISTORY

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

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

    TYPES

    Type of incision:

    Horizontal (lower uterine) Vertical (classical)

    Urgency:
    Emergency (Unplanned, Critical and Crash) Planned (Scheduled and Elective)

    PROCEDURE

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

    Initial incision and multiple layers of incisions

    The uterine incision

    Suctioning amniotic fluids

    Disengaging baby from the pelvis and babys head is born

    Suctioning the Baby

    Babys 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, 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- there should be no strenuous work for up to six months

    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)

    RISKS

    Mother

    Child

    Higher mortality rate than in vaginal birth Abdominal surgery risks


    (postoperative adhesions, 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: 1.77 per 1,000 live births among women who had C-sections/ 0.62 per 1,000 for women who delivered vaginally

    RESEARCH PAPER

    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 womens 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, Professor of Obstetrics and Gynaecology at the University of Dundee

    OXYTOCIN

    BOLUS VERSUS OXYTOCIN

    BOLUS AND INFUSION FOR CONTROL OF BLOOD LOSS AT ELECTIVE CAESAREAN SECTION: DOUBLE BLIND, PLACEBO

    CONTROLLED, RANDOMISED TRIAL

    Murphy D., Sheehan SR, Montgomery AA, Carey M, McAuliffe FM, Eogan M, Gleeson R, Geary M, ECSSIT Study Group
    BMJ 2011;343:120-31

    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

    SAMPLE

    AND

    METHODS

    2069 women booked for elective caesarean section at term with a singleton pregnancy

    excluded placenta praevia, thrombocytopenia, coagulopathies, previous major obstetric haemorrhage (>1000 mL), or known fibroids; women receiving anticoagulant treatment; those who did not understand English; and those who were younger than 18 years

    Double blind, 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 0.9% saline solution over 4 hours (bolus and infusion) Placebo group: 5 IU oxytocin bolus over 1 minute and 500 mL of 0.9% saline solution over 4 hours (placebo infusion) (bolus only).

    conducted from February 2008 to June 2010 in five maternity hospitals in the Republic of Ireland

    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.

    QUESTIONS, PLEASE

    THANK

    YOU!

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