1. Cesarean Birth

2. Definition
An operative procedure to deliver a viable fetus through an abdominal and uterine incisions.
*(American congress for obstetrics and gynecologist)

3. Indication for Cesarean Birth
Cesarean birth is indicated in the following conditions:
Previous cesarean birth
Fetal distress
Uncontrollable third-trimester bleeding
Placenta previa
Abruptio placentae
Fetopelvic disproportion

4. Fetal mal presentation
Prolapsed cord
Medical complications of pregnancy, such as maternal heart disorder
Failure of labor to progress
History of herpes simplex virus infection
12.Diabetes mellitus.

5. Types of Cesarean Birth
There are three types of cesarean births:
Classic Cesarean Birth

6. Transverse Incision:
This is the most common type of cesarean birth, where a transverse incision is made in the lower segment of the uterus.

7. Advantage: Disadvantage:
The advantages of a transverse lower segment incision are easier repair, less blood loss, lower incidence of infection, and less risk of subsequent rupture.
Disadvantage:
These are that it takes more time and requires more surgical skills.

8. The extraperitoneal cesarean birth:
Is less frequently seen and it requires great surgical skills to avoid nicking the bladder

9. Preoperative Care The preoperative nursing care includes:
All the usual procedures for preparing a patient for surgery.
The abdominal skin is prepared.
A Foley catheter is inserted into the bladder to ensure that it is empty.
Elastic stockings are often put on the woman’s leg to reduce peripheral blood pooling and hypotension.

10. The fetal heart rate is recorded with electronic monitoring until the infant is delivered.

11. Preoperative Phase
Begins with decision to proceed with surgical intervention
Baseline evaluation
Preparatory education

12. Intraoperative Phase
Begins when patient is transferred to operating room table
Provide for patient safety
Maintain aseptic environment
Provide surgeon with supplies and instruments
Documentation

13. Postoperative Phase Admission to recovery room Maintain airway
Monitor vital signs
Assess effects of anesthesia
Assess for complications of surgery
Provide comfort and pain relief
Ends with follow-up evaluation in clinical setting or home

14. Preoperative Nursing Management:
Patient Education: * Teaching deep breathing and coughing exercises. * Encouraging mobility and active body movement. e.g Turning(change position),foot and leg exercise. * Explaining pain management. * Teaching cognitive coping strategies.

15. Preoperative Nursing Management:
Managing nutrition and fluids. − The major purpose of withholding food and fluid before surgery is to prevent aspiration. − A fasting period of 8hours or more is recommended for a meal that includes fried or fatty foods or meat * Preparing the bowel for surgery. − Enema is not commonly ordered, unless the patient is undergoing abdomen or pelvic surgery * Preparing the skin. −The goal of preoperative skin preparation is to decrease bacteria without injury to the skin. .

16. Immediate preoperative nursing intervention:
* Administering preanesthetic medication.
* Maintaining the preoperative record.
e.g. Final checklist, consent form, identification.

17. Nursing management in the post anesthesia care unit:
I-Assessing the patient:
Frequent assessment of the patient oxygen saturation, pulse volume and regularity, depth and nature of respiration, skin color ,depth of consciousness.

18. II- Maintaining a patent airway:
− The primary objectives are to maintain pulmonary ventilation and prevent hypoxia and hypercapenia.
− The nurse applies oxygen, and assesses respiratory rate and depth, oxygen saturation

19. Nursing management in the post anesthesia care unit:
III- Maintaining cardiovascular stability:
− The nurse assesses the patient’s mentalGCS sacle
status, vital signs, cardiac rhythm, skin temperature, color and urine output.
− Central venous pressure, arterial lines and pulmonary artery pressure.
− The primary cardiovascular complications include hypotension, shock, hemorrhage, hypertension and dysarrythmias.

20. IV- Relieving pain and anxiety:
− Opioid analgesic.
V- Assessing and managing the surgical site:
− The surgical site is observed for bleeding, type and integrity of dressing and drains.
VI- Assessing and managing gastrointestinal function:
− Nausea and vomiting are common after anesthesia.
− Check of peristalsis movement.

21. VII- Assessing and managing voluntary voiding:
− Urine retention after surgery can occur for a verity of reasons. Opioids and anesthesia interfere with the perception of bladder fullness.
- Abdominal, pelvic ,hip may increase the like hood of retention secondary to pain.

22. VIII- Encourage activity:
− Most surgical are encouraged to be out of bed as soon as
possible. Early ambulation reduces the incidence of post
operative complication as ,atelectasis ,pneumonia,
gastrointestinal discomfort and circulatory problem

23. Post Operative Complication:
1- Shock:
Is the response of the body to a decrease in the circulating volume of blood, tissue perfusion impaired, cellular hypoxia and death.
2- Hemorrhage:
Is the escape of blood from a blood vessel.
3- Deep vein thrombosis. (DVT).
Occur in pelvic vein or in lower extremities.

24. Post Operative Complication:
4- Pulmonary embolism.
It’s the obstruction of one or more pulmonary arterioles by an embolus originating some where in the venous system or in the right side of heart.
5- Urinary Retention.
6- Intestinal obstruction.
Result in partial or complete impairment to the forward flow of intestinal content.

25. Potential Intraoperative complication:
Nausea and vomiting
Anaphylaxis
Hypoxia and other respiratory complication
Hypothermia

26. Postpartum Care
Nursing assessment in this immediate post birth period includes:
Degree of recovery from anesthetic effects.
Postoperative and post birth status and degree of pain.
A patent airway is maintained, and the woman is positioned to perform possible aspiration.
Vital signs are taken every 15 minutes for 1 to 2 hours, or until the woman is stable.

27. The condition of the incisional dressing, the fundus, and amount of lochia are assessed, as well as intake and out.
Deep breathing and leg exercise.
Medication for pain maybe administered.
Physiologic concerns the first few days maybe dominated by pain at the incision site and from the intestinal gas the need for pain relief.
. Ensure proper application and fit of elastic stockings, stocking is to reduce peripheral blood stasis and hypotension.

28. Pain medication usually is ordered every 3 to 4 hours
Pain medication usually is ordered every 3 to 4 hours. Lately care includes perineal care, breast care, and routine vaginal care, including showering after the dress been removed. During each shift the nurse should check the vital signs, the incision, fundus, and lochia. Sounds, bowel sounds, Homan’s sign, and urinary elimination.

29. Discharge Teaching Discharge teaching includes information about: Diet
Exercise
Activity restriction
Breast care
Sexual activity
Contraception
Medications

30. Signs of complications
Abdominal binder

31. Signs of postoperative complications after discharge:
The following signs should be reported to the health care provider:
Fever greater than 100.4˚ (38˚C)
Painful urination
Lochia heavier than a normal menstrual period
Wound separation
Redness or oozing at the incision site
Severe abdominal pain