Cesarean -section

A C-section, also called a cesarean section, is the delivery of a baby through a surgical opening in the lower belly area.

Description
A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child. Surgery is usually done while the woman is awake but numbed from the chest to the feet. This is done by giving her epidural or spinal anesthesia. The surgeon makes a cut across the belly just above the pubic area. The uterus and amniotic sac are opened, and the baby is delivered. The health care team clears the baby's mouth and nose of fluids, and the umbilical cord is clamped and cut. The pediatrician or nurse makes sure that the infant's breathing is normal and that the baby is stable. The mother is awake, and she can hear and see her baby. The father or another support person is often able to be with the mother during the delivery.

Why the Procedure is Performed

The decision to have a C-section delivery can depend on the obstetrician, the delivery location, and the woman's past deliveries or medical history. Some reasons for having C-section instead of vaginal delivery are: Reasons related to the baby:

Abnormal heart rate in the baby Abnormal position of the baby in the uterus such as crosswise (transverse) or feet-first (breech) Developmental problems such as hydrocephalus or spina bifida Multiple babies in the uterus (triplet and some twin pregnancies)

Reasons related to the mother:

Active genital herpes infection Large uterine fibroids low in the uterus near the cervix HIV infection in the mother Previous uterine surgery, including myomectomy and previous C-sections Severe illness in the mother, including heart disease, toxemia, preeclampsia or eclampsia

Problems with labor or delivery:

Baby's head is too large to pass through mother's pelvis (cephalopelvic disproportion) Prolonged or arrested labor Very large baby (macrosomia)

Problems with the placenta or umbilical cord:

Placenta attaches in abnormal location (placenta previa) Placenta prematurely separated from uterine wall (placenta abruptio) Umbilical cord comes through the cervix before the baby (umbilical cord prolapse)

Risks
A C-section is a safe procedure. The rate of serious complications is extremely low. However, certain risks are higher after C-section than after vaginal delivery. These include:

Infection of the bladder or uterus Injury to the urinary tract Injury to the baby

A C-section may also cause problems in future pregnancies. This includes a higher risk for:

Placenta previa Placenta growing into the muscle of the uterus and has trouble separating after the baby is born (placenta accreta) Uterine rupture

All surgeries carry risks. Risks due to anesthesia may include:

Reactions to medications Problems breathing

Risks related to surgery in general may include:

Bleeding Blood clots in the leg or pelvic veins Infection

Outlook (Prognosis)
Most mothers and infants recover well, with few problems. Women who have C-section deliveries can have a normal vaginal delivery with later pregnancies, depending on the type of C-section performed and the reason the C-section was performed. Many women who attempt a vaginal birth after cesarean (VBAC) delivery are successful. However, there is a small risk of uterine rupture associated with VBAC attempts, which can endanger the mother and the baby. It is important to discuss the benefits and risks of VBAC with your obstetric health care provider.

Recovery
The average hospital stay after C-section is 2 to 4 days. Recovery takes longer than it would from a natural birth. Walking is encouraged the day of surgery to speed recovery. Pain can be managed with medications taken by mouth.

Alternative Names
Abdominal delivery; abdominal birth; Cesarean section

Report about

Cesarean section

The MRI Geyser Sign: Acromioclavicular Joint Cysts in the Setting of a Chronic Rotator Cuff Tear
We present the case of a 71-year-old man with a large acromioclavicular (AC) joint cyst successfully managed with surgical excision. AC joint cysts are soft tissue masses generally signifying underlying rotator cuff pathology. Traditionally, these cysts were identified with shoulder arthrography as a geyser of fluid escaping through the AC joint. Magnetic resonance imaging (MRI) is todays preferred imaging modality; we describe the MRI equivalent of the geyser sign, signifying synovial fluid escaping through the cuff defect, across the subacromial bursa, and decompressing superiorly through a degenerated AC joint. Surgical management is preferred for symptomatic cysts. Based on a review of limited retrospective case series, recommendations for management of these lesions are as follows. Repair of the rotator cuff is preferable whenever possible. In the case of an irreparable defect, good results can be achieved through excisional AC joint arthroplasty and resection of the cyst base. Aspiration of these cysts should not be attempted, due to the high recurrence rate and potential for a draining sinus. Hemiarthroplasty also may be effective in indirectly decompressing these cysts; but given the invasive nature of this procedure, it should be reserved for patients who are also symptomatic from cuff arthropathy.

Synovial Chondromatosis of the Shoulder: Open Synovectomy and Insertion of Osteoarticular Allograft With Internal Fixation to Repair Intraoperative Glenohumeral Joint Instability
Synovial chondromatosis is a rare benign disorder characterized by chondroid metaplasia with multinodular proliferation of the synovial lining of a diarthroidal joint, bursa, or tendon sheath. These cartilaginous nodules may become embedded within the proliferating synovium and may extend into the surrounding soft tissues. They also can detach from the synovium, where they can calcify and may present as intra-articular loose bodies. Presence of these nodules leads to joint pain, dysfunction, and ultimately, destruction. Clinically, patients often present with a chronic monoarthropathy.

In this article, we report a case of extensive synovial chondromatosis of the right shoulder and surrounding soft tissues with extensive erosion of the humeral head, discuss combined anterior and posterior surgical excision of the cartilaginous fragments, and describe insertion of an osteoarticular allograft to repair the humeral head defect and secondary anterior glenohumeral joint instability.

Tenosynovial Giant Cell Tumor of the Thigh: Positron Emission Tomography Findings
Tenosynovial giant cell tumors (TGCTs) are pigmented villonodular proliferative lesions originating from the synovium, bursa, or joint. TGCTs tend to be locally aggressive, and there is a chance for multiple occurrences, which often lead to impairment of joint function.

In this article, we report the case of a diffuse-type extra-articular TGCT found in the thigh of a 36-year-old woman. Surveillance F-18 fluorodeoxyglucose positron emission tomography detected increased activity within the left thigh. This activity was confirmed with magnetic resonance imaging and with surgical excision and histopathologic determination of the tumor. This patients case suggests that TGCTs may be discovered and followed after resection with positron emission tomography.

Complications of Anticoagulation for Thromboembolism in Early Postoperative Total Joint Arthroplasty

In the study reported here, we analyzed the complications associated with anticoagulation in total joint arthroplasty patients treated for venous thromboembolism (VTE) in the early postoperative period. Twenty-nine consecutive cases from a 1-year period were identified and retrospectively reviewed. VTE treatment, which in most instances (79%) consisted of a heparin drip, was begun a mean of 2.3 days after surgery. Patients received a mean (SD) of 4.4 (5.0) units of packed red blood cells.

There were no differences in bleeding parameters with respect to timing of initiation of anticoagulation. Local and systemic bleeding complications were common. The proportion of patients who were transfused was significantly (P<.0001) higher for VTE patients than for control patients, and transfused VTE patients received significantly (P = .0004) more blood products.

In total joint arthroplasty patients, VTE treatment began 2.3 days after surgery and had a high incidence of complications related to bleeding.

Operating Room Journal