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Vaginal delivery is the most common way to give birth, but in certain situations, Caesarean section is often
advised. Cesarean section refers to the delivery of the infant through an incision made on the abdominal and uterine
wall.
Indications:
-Fetal malposition
-Fetal distress
-Previous cesarean section
-Abruptio placenta previa
-Cord prolapse
-Prolonged labor, uterine inertia
-Failed trial and induction of labor, failed forceps and vacuum extraction
-Multiple gestation
-Herpes genetalis in active stage
-Other maternal conditions: preeclampsia and eclampsia, heart disease, Rh and ABO Incompatibility
Types of CS:
1. Low Segment / Low-Transverse / Low-Cervical – Incision is made transversely on the lower segment of the
uterus.
Advantages:
Involves less blood loss
Less possibility of rupture of CS scar during subsequent pregnancy
Incision is easier to repair
Less incidence of postoperative complications: infection, adhesion
Less possibility of bowel to the incisional line, Intestinal obstruction
Disadvantages:
Difficult and longer to perform than the classical type
Not recommended with anterior placenta previa
Possibility of incision to extend to the uterine vessels laterally
2. Classical Type / Sanger – A vertical incision is made directly into the walls of corpus, the body of uterine which is
the most contractile portion.
Advantages:
Easiest and quickest incision to perform
Rapid extraction of fetus can be done
Disadvantages:
Involves more blood loss because incision is made on the thick vascular portion of the uterine
Higher incidence of postoperative complications
Rupture of CS scar on subsequent pregnancy and labor is more likely
Involves more healing discomfort and a wider CS scar
3. Extra peritoneal Cesarean Section – Incision is made around the bladder and into the lower uterine segment
without entering the peritoneal cavity.
Advantages:
Useful after prolonged labor
Operation recommended in the presence of amnionitis because spilling of amniotic fluid into the peritoneal cavity is
avoided
Disadvantages:
Operation is difficult to perform
Possibility of uterine bleeding and postoperative infection is high
1. Infraumbilical Vertical Incision – Quickest incision to make which involves performing a 2cm vertical incision at
the level of the anterior rectus sheath. The incision should be long enough to allow delivery of the infant without
difficulty. This incision is made in obese women and in those requiring immediate delivery.
2. Modified Pfannensteil Incision –Lower transverse slightly curvilinear incision is made at the level of the pubic
hairline and extended a little beyond the lateral borders of the rectus muscles. This kind of incision is stronger with
less possibility of dehiscence of hernia formation. This type of incision is made on thin women. Repeat cesarean
section takes longer to perform after this type of incision because if scarring.
PATIENT’S PROFILE:
Name: Mrs. JB Age: 18 y/o Birthday: May 24, 1991 Husband’s age: 23 y/o
Address: Labong, Sta. Lucia, Ilocos Sur
Socio Economic:
Mrs. JB is a housewife. Her husband is an Auto Mechanic worker. He earns P150/day from his job.
Family History:
Most of the member of the family had a difficulty in giving birth, and most often when they give birth it
is through cesarean section.
PHYSICAL ASSESSMENT
I.GENERAL SURVEY
A. GENERAL APPEARANCE
-Conscious and coherent
Trusting, cooperative
B. HEIGHT- 5 feet and 1 inch
WEIGHT- 4 kg
C. VITAL SIGNS
-BP – 110/90
-RR – 22
-PR – 84
-Temp. – 37.5
III. INTEGUMENTARY
A. HAIR and SCALP
-Black hair, No dandruff, No lice
B. SKIN
Brown-skinned
(-) rashes, (-) edema, (-) jaundice and (-) lesion
C. NAILS
-Evenly cut, convex surface
-Capillary refill in 3 seconds
IV. THORAX
A. POSTERIOR and ANTERIOR THORAX
-Symmetrical chest expansion when breathing. Rhythmical normal depth
B. LUNGS
-No rales; no crackles sound
C. HEART
-No murmur sound
V. EXTEMITIES
A. LOWER EXTREMITIES
-No deformities
B. UPPER EXTREMITIES
-No deformities
Fallopian tubes
-Bilateral ducts extends laterally from the uterus
4 parts
1. Infundibulum- funnel shape, with fimbriae
2. Ampulla- widest part; usual site of FERTILIZATION
3. Isthmus- narrowest part
4. Interstitial or Intramural- embedded in the uterine wall
FUNCTION: Transport of ovum
The Uterus
-Pear-shaped organ with a cavity
3 main parts
1. Fundus- upper dome-shape part
2. Corpus or Body- broad part
3. Cervix- narrow lower part
-Isthmus- junction between the body and the cervix
POSITION: Anteverted and Anteflexed
The Uterus
The uterine wall is made up of three layers
1. Perimetrium- superficial part surrounded by the perimetrium
2. Myometrium- thickest muscular part
3. Endometrium- inner layer
FUNCTION: Fetal development in pregnancy
Vaginal canal
-Connects the cervix to the vestibule
-Fibromuscular canal lined with mucus and covered with hymen
-The remnant of hymen is called CARUNCULAE MYRTIFORMIS
FUNCTION: organ of copulation and passageway of baby
External genitalia
1. Vestibule- space between the labia minora
2. Pudendal cleft- space between the labia majora
3. Clitoris- erectile tissue, homologue of penis
4. Labia majora- thick fold of skin, homologue of scrotum
5. Labia Minora- thin fold of skin devoid of hairs
6. Mons pubis/veneris- elevated area above the labia
INSTRUMENT USED:
Sponges: 6, Allis:6, Bladder Retractor: 1 ,Richardson: 1 ,Straight Clamp: 2 ,Curve Clamp: 6 ,Tissue Forceps: 1
,Thumb Forceps: 1 ,Straight Mayo: 1 ,Army Navy: 1 ,Curve Mayo: 1 ,Metz: 1 ,Blade Holder: 1 ,Needle Holder:2
,Blade: 1 ,Towel Clip: 4 ,Needle- 6.
For informed consent, the most common risks, the complications were thoroughly discussed with Mrs. JB and her
family by DR.E.Dauz. An appropriate consent form was signed, indicating Mrs. JB understands the procedure and its
possible complications.
This 18-year-old primigravida was brought to the operating room and placed on the surgical table in a supine position.
Vital signs were stable prior to surgery. Blood pressure was 110/90. Pulse Rate: 84. Respiratory Rate:22. @9:26
Induction of Spinal anesthesia was induce to numb or desentized the lower part of the patient’s body, the patient is
placed in a supine position and the surgical site was prepped by Betadine solution and drape while maintaining a strict
sterile technique. @9:31 after the anesthesia takes effect, the surgeon makes an abdominal incision. The uterus is
exposed through the abdominal wall incision, and an incision is made in the uterine covering. the muscles of the uterus
are separated, producing a hole,
the opening in the uterine wall is where the infant is delivered. After which, The surgeon reaches into the uterus and
lifts the baby's head. A scrub nurse pushes down on the mother's upper uterus to help guide the baby out. @9:35 Baby
was out the scrub nurse suction the baby and the surgeon clamp and cut the umbilical cord. @9:38 the placenta was
out and the surgeon clean thoroughly the uterus, after which, the uterus is stitched closed as well as the incision made
in the abdominal wall. Operation ended around 9:50. Sterile gauze was then placed in the suture line as a dressing.
The patient was awakened and taken to the recovery room in good condition.
LABORATORY RESULTS
Hematology
URINALYSIS
Color Character
yellow slight turbid
Cells
Pus Cells 1-2
RBC 5-7
Squamos few
Bacteria few
NURSING INTERVENTIONS
A. Preoperative:
Explain purpose of procedure to be done
Clarify misconceptions
Check maternal vital signs and FHT
Remove nail polish
Position woman in supine and drape properly.
Advice the woman to ambulate on the first postpartum day
B. Postoperative:
Ensure safety of the patient
Maintain patent airway.
Watch for signs of hemorrhages
DRUG STUDY:
Generic Name: Cefuroxime
Brand Name: Zinacef®
Dosage: 750 mg IV every 8hr ANST (-)
Classification: Cephalosporin, Anti-infective Agents
Action: inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting
biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
Indication: Prophylaxis for surgical infection.
Contraindications: Hypersensitivity to cephalosporins.
Adverse Effect:
-Skin: Pruritus, rash
-GI: Abdominal cramps, diarrhea, nausea, vomiting, oral candidiasis
-GU: Vaginal candidiasis
Nursing Intervention: Monitor for adverse reactions. Most are dose related. Observe patient closely and monitor vital
signs when Midazolam is given parenterally; hypotension, muscular weakness, tachycardia, and respiratory depression
may occur. Monitor I&O ratio, including urinary and bowel elimination.
EVALUATION:
After the surgery, there are no untoward situations that took place. The final BP taken is 120/80 and
there are no difficulties of breathing. Mother is transferred to OB ward via stretcher.
CASE STUDY
ON
CAESAREAN
SECTION
SUBMITTED BY:
ALUSEN, Abner
AMORIN, Ria Joy
CAIREL, Grace Ann Kelly
CASAMIS, Bernard James
DANAO Angelito
GALINO, Eduard
MEANA, Priscila
MONTEMAYOR, Jinky
NAVARRO, Jemarie Grace A.
RIMORIN, Jannil
RUNATAY, Jobert
SAGUN, Jefferson
Clinical Instructor:
MR. Gar-re Garcia RN