Patient N.O.

, 34 years old, with an Obstetrical score of G2P2002 pregnant uterus full term 39 1/7 weeks age of gestation delivered
by Low Segment Transverse Cesarean Section II, a live baby girl with an Apgar score 8,10 Ballard score 39-40 weeks, Body
weight 3150grams appropriate for gestational age premature rupture of membranes (5hours)

Submitted to:
Mrs. Echavez, RN

Submitted by:
Alynah Angelique Alfon Paul Peterson Ng
Marie Louise Go

Juzzen Earl Vitor

Ralph Justin Melgarejo

Jude Ross Avilla

Rufran Arellano

Jephthah Yapha

Marc Ellis Sardoncillo

Cecille Paz Ybanez
Alyannah Jane Buit

Karen Camille Abrenica

Anthony Yap
Geonelle Inferido

Gwen Anthea Orteza

CESAREAN SECTION
A Cesarean Section is a surgical procedure in which incisions are made through a mother's abdomen and uterus to deliver one or more babies. It is usually performed when a vaginal
delivery would put the baby's or mother's life or health at risk; although in recent times it has been also performed upon request for childbirths that could otherwise have been through vaginal
delivery. It is one of the oldest types of surgical procedures known. It is a procedure always slightly more hazardous than vaginal birth. However, when compared with other surgical procedures, it is
one of the safest types of surgeries and one with few complications. The term cesarean birth, rather than cesarean delivery, is used to accentuate that this is a birth more than a surgical procedure.
TYPES

An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus and on the skin.
The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it leaves a wide skin scar and runs through the active
contractile portion of the uterus. Because this type of scar could rupture during labor, it is likely, if this type of incision is used, that the woman will not be able to have a subsequent vaginal
birth.
The Lower Uterine Segment Section is the procedure most commonly used; it involves a horizontal incision across the abdomen just over the symphysis pubis and also horizontally across
the uterus just over the cervix. It is also referred to as a Pfannenstiel incision or a bikini incision, because even a low-cut bathing suit would cover it.
An Emergency Caesarean section is a Caesarean performed once labor has commenced.
A Caesarean Hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be
separated from the uterus.
A Repeat Caesarean Section is done when a patient had a previous Caesarean section. Typically, it is performed through the old scar.

INDICATIONS
Maternal Factors
Active genital herpes or papilloma
AIDS or HIV-positive status
Cephalopelvic disproportion (CPD)
Cervical cerclage
Disabling conditions such as severe hypertension
of pregnancy, that prevent pushing to accomplish
the pelvic division of labor.
Failed induction or failure to progress in labor
Obstructive benign or malignant tumor
Previous cesarean birth by classical incision

Placental Factors
Placenta previa
Premature separation of the placenta
Umbilical cord prolapsed

Fetal 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

Effects of Surgery to the Mother

Just like any other surgical procedures, Cesarean birth also has systemic effects. Whenever the body is in stress, there is a release of epinephrine and norepinephrine from the adrenal
medulla. Epinephrine causes an increased heart rate, bronchial dilation, and elevation of the blood glucose level. It also leads to peripheral vasoconstriction, which forces blood to the central
circulation therefore increases blood pressure. During incisions, the primary line of defense against bacterial invasion is compromised, thats why there is a strict adherence to aseptic and sterile
techniques during surgery an in the days following the procedure to compensate for this impaired defense. Although vessels that must be cut for surgery are immediately clamped and ligated, some

blood loss always occurs with surgery. Extensive blood loss can lead to hypovolemia and lowered blood pressure. This could lead to ineffective perfusion of all body tissues if the problem is not
quickly recognized and corrected. The amount of blood lost in cesarean birth is comparatively high, because pelvic vessels are congested with blood waiting to supply the placenta. During a vaginal
birth, a woman loses 300-400 mL of blood while 500-1000 mL with cesarean birth. When something is done with an organ during surgery, it may respond with a temporary disruption in function.
Pressure from edema or inflammation as fluid moves into the injured area further impairs function of the primary organ involved, as well as that of surrounding organs. Due to the compression of
some blood vessels, distant organs may be deprived of blood flow, leading to reduced function in those organs. Postoperatively, close assessment of total body function is necessary to determine the
total degree of disruption. Because the uterus is handled during cesarean birth, it may not contract well afterward, which can lead to post-partum hemorrhage. For a surgeon to reach the uterus, the
bladder must be displaced anteriorly. As a result of this handling, the bladder may not sense filling as well as usual after the procedure. Lower-extremity circulation may be compromised due to
edema. Surgery also puts pressure on the intestine, so a paralytic ileus or halting of intestinal function is yet another possibility. After a cesarean birth, therefore, uterine, bladder, intestinal, and lower
circulatory function must be closely monitored. Surgery always leaves an incisional scar that will be noticeable to some extent afterward. Fortunately, the scar resulting from cesarean birth (a
horizontal one across the lower abdomen) is not overly noticeable, but its appearance may cause a woman to feel self-conscious later. Although most women accept cesarean birth well, a woman
may feel a loss of self-esteem if she believes it marks her as a woman less than others because she was unable to give vaginal birth.
Risks of the Newborn
Cesarean birth places a newborn at greater risk than does a vaginal birth. When a fetus is pushed through the birth canal, pressure on the chest helps to rid the lungs of lung fluid. Therefore,
respirations are more likely to be adequate at birth than if the fetus had not been subjected to this pressure. For this reason, more infants born by cesarean birth develop some degree of respiratory
difficulty for a day or two after birth than those born vaginally. A newborn is subject to a greater risk of transient tachypnea, which results from slow absorption of lung fluid. It may reflect a slight
decrease in production of phosphatidyl glycerol or mature surfactant. These factors limit the amount of alveolar surface area available to an infant for oxygen exchange. This limitation requires an
infant to increase the respiratory rate and depth to better use the surface available.
OPERATIVE PROCEDURES
Pre-operation:
Adequate circulatory and renal function must be documented immediately preoperatively. Procedures before operation include the following:
Vital signs determination
Urinalysis
Complete blood count
Coagulation profile (prothrombin time [PT], partial thromboplastin [PTT])
Serum electrolyte and pH
Blood typing and cross-matching
Sonogram to determine fetal presentation and maturity
Prior to operation, obtaining an operative consent from the patient is a priority. This ensures legality of the procedures done and that there is agreement between the patient and the
health care team. For gastrointestinal tract preparation, a physician may order an enema before surgery to empty the womans bowel for surgery and allow the bowel to rest for a few days
postsurgery. If an enema is ordered, be certain to administer it is using gentle, gravity-only pressure. To reduce bladder size and keep the bladder away from the surgical field, an indwelling
urinary catheter may be prescribed before transport for surgery or after arrival in the surgical suite. Difficulty with catheterization is greater in pregnant women because the pressure of the
fetal head applies on the urethra and distorts anatomic landmarks. In addition, the vulva may be swollen and distorted from vulval varicosities or edema. Most women have IVF line begun
before surgery with a fluid such as Lactated Ringers solution. Doing so ensures adequate hydration and avoids experiencing of hypotension from epidural anesthesia administration,
temporary use of a supine position.

Intra-operation:
The patient is encouraged to remain on her side, or insert a pillow under her right hip to keep her body slightly tilted to the side, to prevent supine hypotension syndrome. If a
spinal anesthetic is to be administered, the back should be curved to separate the vertebrae and facilitate entry of the spinal needle. Reducing the number of bacteria on the skin before
surgery automatically reduces the possibility of bacteria entering the incision at the time of surgery. After anesthetic administration, a woman is positioned with a towel under her right hip
to move abdominal contents away from the surgical field and to lift her uterus off the vena cava. A screen may be placed at her shoulder level an covered with a sterile drape to block the
flow of bacteria from her respiratory tract to the incision site. This also blocks the patients and the support persons lines of vision, preventing additional anxiety caused by the sight of the
incision. Once surgical incision is complete, retractors are slipped into the incision. Retractors allow good visualization of the uterus and the internal incision. The uterus is then cut, and the
childs head may be born manually or by the application of forceps. The mouth and the nose of the baby are suctioned using a bulb syringe, as same in a vaginal birth after expulsion.
Oxytocin is administered intravenously by the anesthesiologist as the child or placenta is delivered to increase uterine contractions and reduce blood loss. After the full birth, the uterus is
pulled forward onto the abdomen and covered with moist gauze. Once it is determined that the newborn is breathing spontaneously, he or she is shown to the mother and support person,
just as is done after vaginal birth. Visiting with the newborn lays a foundation for bonding and also distracts the couple from the tedious process of incision closure.Women are able to
breast-feed after cesarean births but initial feeding is usually delayed until the woman has been moved to a recovery room because breastfeeding initiates uterine contractions and that it
may interfere with suture placement.
Pos-operation:
The patient will be monitored right after the surgery in the postanesthesia care unit (PACU). If spinal anesthesia was used, client will not be able to help in movement of lower
extremities during transfer to and movements in bed. Patient may report pain related to surgical incision, and may manifest fall in blood pressure (more than 20 mmHg), change in pulse
rate, rapid respirations, restlessness and sense of thirst due to deficient fluid volume in the body related to blood loss during surgery. Patient may also manifest impaired urinary elimination
because of the displacement of the bladder during surgery. The bladders tone or ability to sense filling may be inadequate to initiate voiding after surgery.
PLACENTA PREVIA
Placenta previa is a complication of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
The placenta is the organ that nourishes the developing fetus.
TYPES

Marginal: The placenta is against the cervix but does not cover the opening.
Partial: The placenta covers part of the cervical opening.
Totalis: The placenta completely covers the cervical opening

RISK FACTORS
Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:
Abnormally developed uterus
Many previous pregnancies

 Multiple pregnancy (twins, triplets, etc.)

Scarring of the uterine wall caused by previous pregnancies, cesareans, uterine surgery, or abortions
Women who smoke or have their children at an older age may also have an increased risk. Possible causes of placenta previa include:
Abnormal formation of the placenta
Abnormal uterus
Large placenta
Scarred lining of the uterus (endometrium)
SIGNS AND SYMPTOMS
The main symptom of placenta previa is sudden, painless vaginal bleeding that often occurs near the end of the second trimester or beginning of the third trimester. In some cases, there is
severe bleeding, or hemorrhage. The bleeding may stop on its own but can start again days or weeks later.
There may be uterine cramping with the bleeding. Labor sometimes starts within several days after heavy vaginal bleeding. However, in some cases, bleeding may not occur until after labor starts.
COMPLICATIONS
Risks to the mother include:
Death
Major bleeding (hemorrhage)
Shock
There is also an increased risk for infection, blood clots, and necessary blood transfusions.
Complications of the baby include:
Problems of the baby secondary to acute blood loss
Intrauterine growth retardation
Increased incidence of congenital anomalies
TREATMENT
Treatment depends on various factors:
How much bleeding you had
Where the fetus is developed enough to survive outside the uterus
How much of the placenta is covering the cervix
The position of the fetus
The number of previous births you have had
Whether you are in labor

If the placenta is near the cervix or is covering a portion of it, you may need to reduce activities and stay on bed rest. Your doctor will order pelvic rest, which means no intercourse, no tampons,
and no douching. Nothing should be placed in the vagina. If there is bleeding, however, you will most likely be admitted to a hospital for careful monitoring. If you have lost a lot of blood,
blood transfusions may be given. You may receive medicines to prevent premature labor and help the pregnancy continue to at least 36 weeks. Beyond 36 weeks, delivery of the baby may be
the best treatment. If your blood type is Rh-negative, you will be given anti-D immunoglobulin injections. Your health care providers will carefully weigh your risk of ongoing bleeding against
the risk of an early delivery for your baby. Women with placenta previa most likely need to deliver the baby by cesarean section. This helps prevent death to the mother and baby. An emergency
cesarean may be done if the placenta actually covers the cervix and the bleeding is heavy or life threatening.
OLIGOHYDRAMNIOS
DEFINITION
A deficiency in the amount of amniotic fluid in the gestational sac during pregnancy. It occurs in about 8 out of 100 of pregnancies. It is most common in the last trimester of pregnancy, but
it can develop at any time in the pregnancy. About 1 out of 8 women whose pregnancies last 2 weeks past the due date develops oligohydramnios. This happens as amniotic fluid levels
naturally decline.
SYMPTOMS

Decreased amount of fluid seen on ultrasound

A small for dates womb
Uterine contractions
Abdominal discomfort

DIAGNOSIS
Through ULTRASOUND
CAUSES

Certain birth defects in the baby

Ruptured membranes (breaks or tears in the sac that holds the amniotic fluid)

Birth defects involving the kidneys and urinary tract are the most likely causes of this problem. That's because babies with these birth defects produce less urine, which makes up most of
the amniotic fluid. Some maternal health problems have also been linked with oligohydramnios. These problems include high blood pressure, diabetes, an autoimmune condition called
system lupus erythematosus (SLE),and placental problems.
COMPLICATIONS
Oligohydramnios may affect you, your baby, and your labor and delivery in different ways. The effects depend on the cause, when the problem occurs, and how little fluid there is.
In the first half of pregnancy, too little amniotic fluid may result in birth defects of the lungs and limbs. During this period, oligohydramnios increases the risk of miscarriage, preterm

birth and stillbirth. When oligohydramnios occurs in the second half of pregnancy, it is linked to poor fetal growth. Near delivery, oligohydramnios can increase the risk of complications
during labor and delivery.
TREATMENT
Treatment of any underlying condition
Treatment of any placenta abnormality
Fetal surgery during pregnancy - to correct any fetal abnormality
Induced labor
Cesarian delivery
IRON DEFICIENCY ANEMIA
-most common type of anemia
-also known as sideropenic anemia.
-a condition where one has inadequate amounts of iron to meet body demands such as during periods of rapid growth and pregnancy.
CAUSES:

diet insufficient in iron

blood loss

parasitic infections such as hookworms

growth spurt

can be secondary to Gaucher disease

poor absorption of vit. C in the bodyfatigue, irritability, dizziness, weakness, shortness of breath, sore tongue, brittle nails, decreased appetite (especially in children), headache frontal.
SIGNS AND SYMPTOMS:

pallor (reduced amount of oxyhemoglobin in skin or mucous membrane)

fatigue and weakness. Because it tends to develop slowly, adaptation occurs and the disease often goes unrecognized for some time.
dyspnea (trouble breathing) can occur
Unusual obsessive food cravings
Pagophagia or Pica for ice
Hair loss and lightheadedness
shortness of breath
sore tongue
brittle nails
decreased appetite
fainting or feeling faint

DIAGNOSIS

maybe diagnosed from signs and symptoms

often first shown by routine blood tests
hemoglobin and serum ferritin
serum transferrin
bone marrow aspiration

TREATMENT

eating of organ meats along with essential vitamins and minerals - when due to diet, pregnancy, growth spurts, blood loss caused by heavy period or internal bleeding
URINARY TRACT INFECTION

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not have
bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis.
Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious. Although they cause discomfort, urinary tract infections are usually quickly and easily treated by
seeing a doctor promptly.
Signs and symptoms for Bladder Infections:
o Frequent urination along with the feeling of having to urinate even though little or no urine actually comes out.
o Nocturia: Need to urinate during the night.
o Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with urination (dysuria).
o Cystitis: Pain in the midline suprapubic region.
o Pyuria/Hematuria: Pus or blood in urine.
o Pyrexia: Mild fever
o Discharge from the urethra.
o Cloudy and foul-smelling urine
o Increased confusion and associated falls are common presentations to Emergency Departments for elderly patients with UTI.
o Some urinary tract infections are asymptomatic.
DIAGNOSIS:
A patient with dysuria (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for urinalysis, specifically the presence of nitrites, leukocytes or leukocyte
esterase. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. The diagnosis of UTI is confirmed by a urine culture.
If the urine culture is negative:
Symptoms of urethritis may point at Chlamydia trachomatis or Neisseria gonorrheae infection.
Symptoms of cystitis, may point at interstitial cystitis.
In men, prostatitis may present with dysuria.
In severe infection, characterized by fever, rigors or flank pain, urea and creatinine measurements may be performed to assess whether renal function has been affected.
Causative agents:

Common organisms that cause UTIs include: Escherichia coli and Staphylococcus saprophyticus. Less common organisms include Proteus mirabilis, Klebsiella pneumoniae, Enterobacter
spp., Pseudomonas and Enterococcus spp.
A mnemonic that can be used to remember the bacteria that cause UTIs is SEEK PP (Staph saprophyticus, E. coli, Enterococcus, Klebsiella, Proteus, Pseudomonas).
PREVENTION:
The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:
o
o
o
o
o
o
o
o

Cleaning the urethral meatus (the opening of the urethra) after intercourse has been shown to be of some benefit; however, whether this is done with an antiseptic or a placebo ointment (an
ointment containing no active ingredient) does not appear to matter.
It has been advocated that cranberry juice can decrease the incidence of UTI (some of these opinions are referenced in External Links section). A specific type of tannin found only in
cranberries and blueberries prevent the adherence of certain pathogens (eg. E. coli) to the epithelium of the urinary bladder.
Cleaning genital areas prior to and after sexual intercourse.
For sexually active women, and to a lesser extent men, urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor
the bacteria to the walls of the urethra.
Having adequate fluid intake, especially water.
Not resisting the urge to urinate.
Taking showers, not baths, or urinating soon after taking a bath.
Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens.

Epidemiology:
UTIs are most common in sexually active women, and increase in diabetics and people with sickle-cell disease or anatomical malformations of the urinary tract. Allergies can be a hidden
factor in urinary tract infections. For example, allergies to foods can irritate the bladder wall and increase susceptibility to urinary tract infections. Keep track of your diet and have allergy testing
done to help eliminate foods that may be a problem. Urinary tract infections after sexual intercourse can be also are due to an allergy to latex condoms, spermicides, or oral contraceptives.
The use of urinary catheters in both men and women who are elderly, people experiencing nervous system disorders and people who are convalescing or unconscious for long periods of
time may result in an increased risk of urinary tract infection for a variety of reasons. Scrupulous aseptic technique may decrease this risk.
The bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium. As binding is an
important factor in establishing pathogenicity for these organisms, its disruption results in reduced capacity for invasion of the tissues. Moreover, the unbound bacteria are more easily removed
when voiding. The use of urinary catheters (or other physical trauma) may physically disturb this protective lining, thereby allowing bacteria to invade the exposed epithelium.
Elderly individuals, both men and women, are more likely to harbor bacteria in their genitourinary system at any time. These bacteria may be associated with symptoms and thus require
treatment with an antibiotic. The presence of bacteria in the urinary tract of older adults, without symptoms or associated consequences, is also a well recognized phenomenon which may not require
antibiotics. This is usually referred to as asymptomatic bacteriuria.
Women are more prone to UTIs than males because in females, the urethra is much shorter and closer to the anus than in males.

TREATMENT
If the UTI is treated early, the use of antibiotics may be avoided. Several products are available over the counter. Most uncomplicated UTIs can be treated with oral antibiotics such as
trimethoprim, cephalosporins, nitrofurantoin, or a fluoroquinolone (e.g. ciprofloxacin, levofloxacin). Whilst co-trimoxazole was previously internationally used the additional of the sulphonamide
gave little additional benefit compared to the trimethoprim component alone, but was responsible for its both high incidence of mild allergic reactions and rare but serious complications. If the
patient has symptoms consistent with pyelonephritis, intravenous antibiotics may be indicated. For acute pyelonephritis, use Aminoglycoside plus Ampicillin (I.V.).