Laparotomi Ambil Anak ( Laparotomy removal of fetus ) vs Hysterotomy vs Caesarean Section

Terminologi :

Laprotomi : Prosedur Bedah dimana seorang dokter bedah melakukan incisi besar pada abdomen
untuk melakukan akses pada organ intraabdomen untuk memperbaiki atau mengangkat organ,
dalam hal obstetri ginekologi untuk mengakses organ dalam reproduksi, uterus, tuba dan ovarium
 Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F (May 2002). "Pfannenstiel versus Maylard incision for
cesarean delivery: A randomized controlled trial". Obstetrics and Gynecology. 99 (5 Pt 1): 745–50. doi:10.1016/S0029-
7844(02)01957-9. PMID 11978282.

Tizzano AP, Muffly TM (2007). "Historical milestones in female pelvic surgery, gynecology, and female
urology." (PDF). Urogynecology and Reconstructive Pelvic Surgery (3rd ed.). pp. 3–15.

Baik Laparotomy removal of fetus vs Hysterotomy vs Caesarean Section seluruhnya dilakukan melalui
prosedur Laparotomi

Laparotomy Removal of The Fetus

Laparotomi yang dilakukan pada kehamilan ektopik yang tidak memungkinkan Bayi/Fetus dilahirkan
melalui proses persalinan

Laparotomi ambil anak dapat dilakukan pada advance abdominal pregnancy ( Hepatic pregnancy,
splenic pregnancy

Kehamilan ektopik trimester awal dapat dilakukan evakuasi secara Laparoskopi

Masukume, Gwinyai (2014). "Insights into abdominal pregnancy". WikiJournal of Medicine. 1 (2). doi:10.15347/wjm/2014.012.

Worley, K. C.; Hnat, M. D.; Cunningham, F. G. (2008). "Advanced extrauterine pregnancy: Diagnostic and therapeutic
challenges". American Journal of Obstetrics and Gynecology. 198 (3): 297.e1–
7. doi:10.1016/j.ajog.2007.09.044. PMID 18313451.

Mahajan, N. N. (2008). "Advanced extrauterine pregnancy: Diagnostic and therapeutic challenges". American Journal of
Obstetrics and Gynecology. 199 (6): e11, author reply e11–2. doi:10.1016/j.ajog.2008.06.024. PMID 18639214.

Gibbs, Ronald S (2008). Danforth's obstetrics and gynecology (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
p. 84. ISBN 9780781769372.

Caesarean section

A cesarean section is the delivery of a fetus through an abdominal and uterine incision;
technically, it is a laparotomy followed by a hysterotomy.1 This definition considers only the
location of the fetus and not whether the fetus is delivered alive or dead

1 Gabert HA, Bey M: History and development of cesarean operation. Obstet Gynecol Clin  
North Am 15:591, 1988

2 Speert H: A Pictorial History of Gynecology and Obstetrics. Philadelphia, Davis, 1973

Mengacu kepada terminologi dan pengertian sectio caesaria, seluruh prosedur sectio caesaria
dilakukan hysterotomy atau teknik membuka uterus
There are three standard uterine incisions that can be performed for delivery of the fetus: low transverse, low vertical, and
classical (Fig. 3). The specific type of uterine incision should be determined by the primary surgeon at the time of the
operation based on gestational age and lie of the fetus and any uterine anomalies. One of the important factors to be assessed
before incising the uterus is the width of the lower segment (the distance between the broad ligaments). This should be
assessed in relation to the size of the baby to decide whether a transverse or longitudinal incision is most appropriate. In
either case, the peritoneum needs to be reflected inferiorly before the uterine incision is made. 27

Fig. 3.  Uterine incisions. A. Low-transverse uterine incision should be

made through the thin, noncontractile portion of the lower uterine segment
in a curvilinear fashion. Also pictured is a low-vertical incision, which is
made through the noncontractile lower uterine segment in a vertical
fashion.  B.  J-extension of the low-transverse incision. When additional
exposure to the uterine cavity is required to deliver the fetus, the low-
transverse incision can be extended laterally and cephalad to increase the
length of the incision without endangering the uterine arteries.  C. Another
option in this situation is to use a T-extension in the midline.  D. The
classical uterine incision is made through the contractile portion of the
myometrium above the bladder reflection.

Historically, the creation of a bladder flap was advocated before making any uterine incisions. More recently, randomized
controlled trials have noted that the omission of the bladder flap provides short-term advantages such as reduction of
operating time and incision–delivery interval, reduced blood loss and need for analgesics. Practically speaking adequate
access to the lower segment may require some dissection but this should be kept to what is needed and not be excessive. The
peritoneum is grasped with a pair of forceps, elevated, and then incised transversely with scissors. Next, the inferior portion
of the peritoneum is elevated from the lower uterine segment. A Doynes retractor should then be inserted to keep the bladder
clear of the surgical field. Before making the uterine incision, the surgeon should also identify the round ligaments to assess
the degree of dextra-rotation of the uterus and to evaluate for the presence of any myomas or other malformations that
might affect the choice and/or placement of the incision.

Story L, Paterson-Brown S: Cesarean deliveries: indications, techniques and

complications. Chapter 10: Best Practice in Labour and Delivery, ed. R. Warren and S.
Arulkumaran. Published by Cambridge University Press 2009.

Perkembangan sectio caesaria dilakukan pada low uterine segment atau lebih dikenal dengan Sectio
Caesaria Transperitoneal Profunda atau irisan hysterotomy dilakukan pada segmen bawah rahim
( Supracervical ) dikarenakan sectio caesaria secara klasik cenderung mengakibatkan cedera VU,
perdarahan yang banyak dan waktu yang lama, sehingga pengembangan teknik bladder flap dan
irisan segmen bawah rahim ( low transverse uterine segmen incision ) semakin berkembang
Lower uterine segment incision

The standard low-segment transverse incision accounts for 90% of all uterine incisions. 17 This incision should be made 2–3 cm
below the upper edge of the uterovesical fold of peritoneum. This is especially important when the cesarean is performed at or
near full dilatation, as the tendency is to go in too low, due to the stretched and ballooned out lower segment. A low entry in this
situation risks extension of the uterine angles into the broad ligament, or even more dangerously it can risk entry into the
vagina (inadvertent laparoelytrotomy) – both complications carry attendant risks to the ureters. The incision is then made
sharply with the scalpel in the midline and performed down to the level of the fetal membranes, with care being made not to
incise the membranes, and extended laterally using either blunt dissection with the fingers or scissors (Fig. 4). It is best to try to
leave the membranes intact at this stage in order to avoid the risk of cutting the baby and to maintain the liquor until the
uterine incision is completed (particular attention to avoid cutting the baby is necessary where the membranes have already
ruptured, in cases of oligohydramnios, breech presentations, advanced labor or after repeat cesarean, where the lower segment
can be very thin).27 There was thought to be no difference between the two methods of extending the uterine incision in amount
of blood lost or in the rate of extension of the incision into the lateral uterine vessels when they were compared and correlated
by the stage of labor.39 However, a recent investigation revealed a greater risk of subsequent blood transfusion in women whose
incision was extended sharply compared to those extended bluntly. 40 When blunt dissection is used, an upward curve of the
incision may be created by the surgeons placing their thumbs on the patient's anterior superior iliac spines and index fingers in
the uterine incision. By keeping the hand in this position, the incision is pulled open in an arc.
 Fig. 4. Extension of the lower uterine incision may be accomplished by
either inserting fingers into the uterine cavity and bluntly stretching the
myometrial incision in a curvilinear fashion or sharply cutting the lower
uterine segment with bandage scissors. When the uterus has a poorly
developed lower uterine segment, using bandage scissors is often
preferable.

Rodriquez AI, Porter KB, O'Brien WF: Blunt versus sharp expansion of the uterine incision in  
low-segment transverse cesarean section. Am J Obstet Gynecol 152:971, 1985

Boyle JG, Gabbe SG: T and J Vertical extensions in low transverse cesarean births. Obstet
Gynecol 87:238, 1996

Parliamentary Office of Science and Technology. Cesarean sections. Postnote 2002;(184): 1–4
[www.parliament.uk/ post/pn184.pdf]