CAESAREAN SECTION

history, development and clinical

implication
 History
• Caesarean
• Mitos : J. caesar
dilahirkan dari ibu
Aeralius

The extraction of Asclepius from the abdomen of his mother Coronis by

his father Apollo. Woodcut from the 1549 edition of Alessandro
Beneditti's De Re Medica.
 History
• J. Caesar melakukan
invasi ke Inggeris, Ibu
merestuinya

One of the earliest printed illustrations of Cesarean section. Purportedly

the birth of Julius Caesar. A live infant being surgically removed from a
dead woman. From Suetonius' Lives of the Twelve Caesars, 1506 woodcut.
 Developing country
• Seksio dilakukan pada
ibu yang
sekarat/meninggal

Successful Cesarean section performed by indigenous

healers in Kahura, Uganda. As observed by R. W. Felkin in
1879.
 • Embriotomi

Craniotomy. Perforation of the skull, removal of cranial contents, and

extraction of the collapsed skull.
 Contraindication

• Fetal malformation
• < 28 week pregnancy
• DIC
 Indication

Philosophy : The procedure

should be on scientific base , for
the sake/benefit of the patient
and with least burden.
Risk
Risk of maternal death due to CS
Trend of rising CS rate

• Belanda dengan angka

seksio yang rendah
mempunyai angka
kematian ibu dan
perinatal yang rendah di
dunia
Indication of CS by country
 Indications
• Dystocia
• Placenta previa & abruptio
• Fetal distress
• Shoulder pres.
• Prev. CS
• Breech
• Triplets++
Dystocia
 Antepartum hemorrhage

• Indikator plasenta
previa
• USG pada kehamilan >
37 mgg

Dikutip dari: Cuningham dkk, 2001

 Dystocia
• The use of PARTOGRAM

• CPD – head or abdominal circumference of

>35 cm;
• Contracted pelvis (Ro or CT) - incidence of
1%
• Malpresentation - posterior occiput
• Malposisi
 Vasa Uterina
• Risk of laceration
• ‘U’ incision is the best
avoiding the vessels
• Hemostatic stitch 
perpendicular to the
vessels

Dikutip dari: Cuningham dkk, 2001

 Opening the low segment
• Lebih baik dengan cara
avue : Gunting arah
keatas ! Bentuk U
• Hindari pelebaran
tumpul mencapai vasa
uterina

Dikutip dari: Cuningham dkk, 2001

Dikutip dari: Cuningham dkk, 2001
 Fetal Hypoxia
• Severe Preeclampsia
• FDJP /Biophysical profile < 6
• CTG : Severe deceleration, non reactive
• Thick meconium
• Placental Insufficiency : Postterm > 42 mgg
• Prolaps t.pusat
• READY FOR RESCUCITATION
 Complications
• PROBLEM • PREVENTION
• laceration • ‘U’incision
• hematoma • Hemostatic stitches
• Bleeding from LS
• Stitches, tampon

• Delivery of infant
• forsep, vacuum,
extraction
• placenta di depan
• insisi longitudinal rdh
 Complication

• Robekan
• Hematoma
• Perdarahan dari insersi
• Atonia
• Kesulitan pengeluaran
kepala
• Malposisi kepala
Dikutip dari:W.C. Wong et al 2001
Low longitudinal Incision

• Indication :
•
• preterm
• Placenta previa in
anterior
• Shoulder pres.
Emergency CS

• INDIKASI: Keadaan umum

buruk, risiko anestesi
umm/regional
• CARA: Infiltrasi lidokain
0.5% ,
• Atau: ketamin 50 mg bolus
+ Tetes Ketamin 100
mg/500 RL
 Intraoperative

• Spinal is the best

• Antiseptic
• Universal precaution
• Facilities, vital
monitoring
• recording
 Trends
• Amerika berusaha
untuk mencapai tingkat
angka seksio 15%

Dikutip dari: Cuningham dkk, 2001

 When is it safe for next
pregnancy ?
• Risik of uterine rupture will increase if
interval is less than 18 months.
• Evaluation of the thickness of low segmen
at term.
• Rozenberg (1996): risk of uterine rupture
increase if < 3.5 mm – sensitifity 88%,
specificity 99%.
Contraindication for VBAC
• Contracted pelvis
• Macrosomia
• Classic incision or deep myomectomy
• Overdistended
• Readiness for emergency CS (?)
Dikutip dari: Cuningham dkk, 2001
Dikutip dari: Cuningham dkk, 2001
INFORMED CONSENT

Information on indication, risk

and benefit
 AUDIT
• Regular Maternal Perinatal meeting
(weekly/monthly)
• Review for indications (e.g fetal distress)
• Morbidity
• Guidelines (EFM)
• May reduce the rate
• Report and dissemination