Cesarean Delivery or Cesarean Section: Types, Indications, Management, Complications, Nursing intervention

 Cesarean Delivery or Cesarean Section

Cesarean delivery also known as cesarean section is the surgical delivery of the baby from the uterus through an abdominal incision.

Different types of cesarean section

Uterine Incisions types

Incision option is based on the clinical condition and future fertility and uterine health.

• Low transverse: transverse incision made across the lower uterine segment.
• Classic: vertical incision from the funds down the body of the uterus to the lower uterine segment; may be utilized for emergent or preterm deliveries.
• T-extension ( low transverse with midline vertical incision extending upward from the middle of the horizontal incision)

Abdominal incision type 

• Pfannenstiel incision: a horizontal incision across the suprapubic area.
• Vertical incision: a midline vertical incision from below the umbilicus to the symphysis pubis.

Indications

Maternal complications (medical)

• Asthma
• Hypertension
• Heart disease

Labor Complications

• Dystocia
• Malpresentation
• CPD
• Complications in first or second stage of labor

Obstetric Complications

• Placenta previa
• breech
• elective induction of nulliparous

Common indications for cesarean hysterectomy

• Ruptured uterus
• uterine infection
• PPH
• Placenta accreta
• Gross multiple fibromyomas 
• Uterine inversion unresponsive to manual replacement 

Management 

preoperative management 

• Keep patient NPO before surgery (6-8hr)
• Send blood for pre-surgical profile
• Consents signed and witnessed.
• Provide I.V. fluid support according to patient condition
• Perform urinary catheterization 
• Administer an antacids 
• May need prophylactic antibiotic 

postoperative

• Assist the patient to recovery room
• Monitor vitals 
• Watch any bleeding
• Maintain hydration
• Monitor urine output

Major complications of cesarean section

• Bleeding
• Uterine infection 
• Intestinal obstruction
• Pulmonary embolism
• Anesthesia complications
• Surgical injury

Nursing diagnoses

• Anxiety-related to surgical procedure
• Acute pain related to surgical incision
• Risk for infection related to surgical procedure

Nursing interventions

Relieving anxiety

• Explain the indication of cesarean section 
• Answer all questions
• Allow the relatives person to attend the birth if appropriate.
• Inform patient and significant other of procedural progress.

Promote comfort

• Administer proper pain medications
• Monitor respiratory status up to 24 hr after epidural opioid administration.
• Guide the patient to use of patient-controlled anesthesia pump if available.
• Support the abdominal incision when moving or coughing.
• Encourage ambulation.

Preventing infection

• Maintain sterile technique especially during dressing
• Provide perineal care
• Provide routine postoperative care measures