Caesarean section

nursing

1. P R E S E N T A T I O N O N "CESAREA N SECTION" SUBMITTED TO Mrs. SNEHLATA PARASHAR M.SC LECTURER (OBG & GYN) SUBMITTED BY Mr. MANISH BAKLIWAL B.SC NURSING 4 TH YEAR (BATCH- 2016-17) SUBMISSION DATE :-

2. O B J E C T I V E :- Introduction Definition Types Indication Complication Technique Management

3. Caesarean section , also known as C - section , or caesarean delivery, is the use of surgery to deliver babies. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk. D E F I N I T I O N :- "A surgical procedure involving incision of the walls of the abdomen and uterus for delivery of offspring." I N T R O D U C T I O N:-

4. T Y P E :- 1. ACC. TO TIMING It is devied into 2 type. ( A ) ELEC T I VE ( B ) E MERGE N C Y ELECTIVE :- A caesarean section ( c - section ) is an operation where a doctor makes a cut in your abdomen and womb and lifts your baby out through it. If you know you will need a c - section before you go into labour, this is called a elective planned c - section . EMERGENCY:- If labour has already begun, and a complications begin, then an emergency c - section is performed . ACC. TO UTERINE INCISION It is further divide into 2 type:- Lower segment Caesarean section Upper segment Caesarean section

5. LSCS USCS Incision make 3 cm. above the symphysis pubis. Less amount blood loss. Less chances to hernia. High cosmetic value. Better healing process occur Incision make above umbilicus & below fundus part. High amount blood loss. High chances to hernia. Less cosmetic value. Healing process delay.

6. INDICATION:- A Caesarean section is performed for a variety of indications. The following are the most common :- Breech presentation (at term) – planned Caesarean sections for breech presentation at term. Oth e r m a lpresen t a tions – e . g. unstable lie  transverse lie or oblique lie.  Twin pregnancy – when the first twin is not a cephalic presentation. Mat e r n a l M edica conditions (e.g. c a rd i omyopat h y) W h e r e labour w o u ld b e dangerous for the mother. Transmissible disease (e.g. poorly controlled HIV). Placenta praevia – ‘Low-lying placenta’ where the placenta covers, or reaches the internal os of the cervix.

7.  Mat e r n a l diabet e s - with a ba by e stima t ed t o have a fetal weight >4.5 kg. Complications:- Lung aspiration. Pulmonary embolus . Postpartum haemorrhage . Infection: being overweight and obesity are significant risk factors for infection post-caesarean. Longer stay in hospital may lead to difficulties in bonding and adjustment difficulties for the mother and the rest of the family.

8. Te chni que :- "During Delivery" (A). The skin incision is done along the skin folds. (B). T he fascia are dissected above pyramidalis muscles . (C). The uterotomy is done using blunt Forceps & scissors . (D). The baby is “born ” by Expanding th e uterine wound using the fingertips to cranially push t he edges of the wound.

9. "A FTER DELIVERY " (A). The first suture stitch is placed slightly medially from the anatomical corner of the wound. The same suture thread is used to make 2–4 more continuous sutures and the ends of the suture thread are knotted. (B). Analogously a second suture thread is used to close the uterine wall starting from the other side . (C). Both sutures are knotted in the middle. (D). subsequently the suture is buried by knotting the suture threads.

10. Management:- PRE-OPREATIVE:- In preparation of patient C-section, you will be asked to Dr. & do the following : (a) Provide a hospital gown and send a urine sample to lab. (b) Have an intravenous line (IV) started in patient's arm or hand. Through this you will administrate necessary fluids and medications as needed. (c) P rovide blood drawn test. (d) Nurse may be give antacid medicine to neutralize stomach acidity and relieve from heartburn. (e) Clear surgical site prepared (shaved). Do not do this in advance. (f) Be examined by your obstetrician and anesthesiology specialist, and asked to sign a consent form.

11. INTRA-OPERATIVE:- (a) Support and assist in positioning the patient during insertion of spinal/epidural anaesthetic. (b) For elective sections where appropriate fetal heart ch e c ke d pri o r t o an d foll o win g  in s e r t i on of epidural/spinal anaesthesia. Document in clinical record. (c) For emergency sections monitoring of the fetal heart is di r ected b y t h e m ost se n io r  obste tr ic doctor present. (d) Assist with positioning of patient for catheterisation and surgery.

12. POST-OPERATIVE Transfer to postpartum ward when pt . S table vital sign c heck 15 minutes for 1 hour , then check 4 hours. Monitor intakes and outputs every 4 hours for 24 hours A ctivity : o Bed rest o Supine for 8 hours after spinal anesthetic Standard Diet o Nothing by mouth for 8 hours after cesarean section o Sips of water after 8 hour window Early Solid Diet Protocol o Solid food within 8 hours of C-Section o Well tolerated Intravenous fluids Contact physician for : 1.Temprature 2.Heart rate respiratory rate. 3.Ute rine output foleys catheter in place.

13. Medications: 1.Antibiotics medicine: (A). Ceftriaxone (B). Amoxicillin 2.Pain medicine: (A). pethidin hydrochloride (B). Motrin Metachlor promide. Iron Sulfate dosing based on Postpartum Anemia . Oxytocine