CESAREAN BIRTH

Birth accomplished through an abdominal incision into the uterus.

Indications for Cesarean Birth Maternal Factors o Active genital herpes or perhaps human papillomavirus o Cephalopelvic disproportion o Cervical Cerclage o Disabling conditions, such as severe hypertension of pregnancy that prevent pushing to accomplish the pelvic division of labor o Failed induction or failure to progress in labor o Obstructive benign or malignant tumor o Previous cesarean birth by classic incision Placenta Factors o Placenta Previa o Premature separation of the placenta o Umbilical cord prolapse Fetal o o o o o o Factors Compound conditions such as macrosomic fetus in a breech lie Extreme low birth weight Fetal distress Major fetal anomalies, such as hydrocephalus Multigestation or conjoined twins Transverse fetal lie

BREECH PRESENTATION
Breech presentation means that either the buttocks or the feet are the first body parts that will contact the cervix.

Three Types of Breech Presentation TYPE Complete LIE Longitudinal ATTITUDE Good (full flexion) DESCRIPTION The fetus has thighs tightly flexed on the abdomen; both the buttocks and the tightly flexed feet present to the cervix.

Frank

Longitudinal

Moderate

Attitude is moderate because the hips are flexed but the knees are extended to rest on the chest. The buttocks alone present to the cervix. Neither the thighs nor lower legs are flexed. If one foot presents, it is a single-footling breech; if both present, it is a double-footling breech.

Footling

Longitudinal

Poor

Causes of Breech Presentation Gestational age less than 40 weeks Abnormality in a fetus, such as anencephalus, or meningocel. (In a fetus with hydrocephalus, the widest fetal diameter is the head, so it retains the most comfortable position. Hydramnios that allows for free fetal movement so that the fetus fits within the uterus in any position. Congenital anomaly of the uterus, such as a midseptum that traps the fetus in a breech presentation. Any space-occupying mass in the pelvis, such as a fibroid tumor of the uterus or a placenta previa, that does not allow the head to present. Pendulous abdomen. If the abdominal muscles are lax, the uterus may fall so far forward the fetal head comes to lie outside the pelvic brim, causing a breech presentation. Multiple gestation. The presenting infant cannot turn to a vertex position.

Breech Presentation Diagnosis Clinical Examination o Abdominal o Vaginal Radiological Examination o X-ray o Utrasound Scan (Confirmatory) confirm lie and type of breech assess head position obtain estimate of fetal weight assess for IUGR and congenital anomalies assess amniotic fluid volume confirm placental localization

Mode of Delivery Criteria for Vaginal Breech Delivery or Cesarean Section Vaginal Breech Delivery Estimated fetal weight is 2.5 3.5 kg Adequate maternal pelvis No obstetrics complication Cesarean Section Fetal weight >3.5 kg Any abnormality of the bony pelvis Previous difficulty of labor Hyperextension of fetal head Inta-uterine Growth Retardation

Management of Breech Identification of the complicating factors External Cephalic Version - a non-surgical technique to move the baby in the uterus, done at 32 34 weeks of gestations. In this procedure, a medication is given to help relax the uterus. There might also be the use of ultrasound to determine the position of the baby, the location of the placenta and the amount of amniotic fluid in the uterus. Gentle pushing on the lower abdomen can turn the baby into the head-down position. Throughout the external version the babys heartbeat will be closely monitored so that if a problem develops, the health care provider will immediately stop the procedure. External version has a high success rate. However, this procedure becomes more difficult as the due date gets closer. Criteria for ECV: a normal fetus with reassuring fetal heart trackings adequate amniotic fluid presenting part not in pelvis no uterine operative history no labor Planning the mode of Delivery Vaginal Delivery Cesarean Section NURSING INTERVENTIONS Pre 1. Bed rest in left lateral position to prevent early rupture of membrane and cord prolapse. 2. If delay progress/cs:- nothing per oral. 3. Adequate parenteral nutrition

4. Vaginal examination should be perform only when the membrane ruptures to exclude cord prolapse. Intra Vaginal Delivery 1. Avoid pushing before full dilatation 2. Assess for and perform episiotomy if required when anus stays in view between contractions 3. Hands off until there is reason to assist 4. Position of choice: all fours Intra Cesarean Section 1. Available intravenous line to allow getting of fluids and medications during surgery. 2. Abdominal skin preparation. The abdomen will be washed, and the pubic hair may be clipped or trimmed. 3. Catheter in place to drain the bladder because keeping the bladder empty decreases the chance of injuring it during surgery. Post 1. Monitoring of vital signs 2. Prevention of shock by monitoring blood loss 3. Measures in preventing complications.