MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Telefax number: 078-3041010/ E-mail address: admino College of Nursing ffice@mcnp.edu.

Web site: www.mcnp.edu.ph

PERIOPERATIVE
NURSING
MEMBERS

Sabado, Mary Joy

Santiago, Charisse Ann
Singueo, Stefanie Mae
Suyu, Liana Marie
Tumaneng, Aubrey Nikolle
Utayde, Cassey Faith
Uy, Jelaine
Abalos, Fatima Castro,
Reabel

Jay Ann B. Rapano, RN, MSN

Clinical Instructor
 MEDICAL COLLEGES OF NORTHERN
PHILIPPINES

Telefax number: 078-3041010/ E-mail address: admino College of Nursing ffice@mcnp.edu.ph

Web site: www.mcnp.edu.ph

CESAREAN
SECTION
MEMBERS

Sabado, Mary Joy

Santiago, Charisse Ann
Singueo, Stefanie Mae
Suyu, Liana Marie
Tumaneng, Aubrey Nikolle
Utayde, Cassey Faith
Uy, Jelaine
Abalos, Fatima Castro,
Reabel

Jay Ann B. Rapano, RN, MSN

 Clinical Instructor
What is a cesarean section?

A cesarean section, also called a c-section, is a surgical procedure performed when a vaginal
delivery is not possible or safe, or when the health of the mother or the baby is at risk. During
this procedure, the baby is delivered through surgical incisions made in the abdomen and the
uterus.

INDICATIONS:
A. Maternal Indications:
✓ Contracted pelvis and cephalopelvic disproportion.
✓ Cervical cancer or presence of tumors in the pelvic especially if impacted.
✓ Antepartum hemorrhage.
✓ Pregnancy incduced hypertension, preeclampsia, eclampsia.
✓ Abnormal uterine actions.
✓ Previous uterine scar as hysterotomy or metroplasty.
✓ Previous successful repair of vesico-vaginal fistula.
✓ Previous caesarean section if,
a. the cause of the previous section is permanent (contracted pelvis)
b. Previous section was upper segment.
c. Suspected weak scar, as evidenced by:
– Puerperal infection.
– Hysterosalpingography or hysteroscopy done reveals a defect in the scar.
– Vaginal bleeding during current labor.
– Marked tenderness over the scar during current labor.
– Associated conditions as antepartum hemorrhage or malpresentations. B. Fetal Indications:
✓ Malpresentation and malposition.
✓ Prolapsed pulsating umbilical cord, or fetal distress before full cervical dilatation.
✓ Diabetes mellitus or Large for Gestational Age.
✓ Bad obstetric history as recurrent intrauterine fetal death in last weeks of pregnancy or
repeated intranatal fetal death.
✓ Post mortem CS done within 10 minutes of maternal death to save living baby.

CONTRAINDICATIONS:
1. Dead fetus except in:
a. Extreme degree of pelvic contraction.
b. Neglected shoulder
c. Severe accidental hemorrhage. 2. Disseminated intravascular coagulation
3. Extensive scar or pyrogenic infection in the abdominal wall (e.g. Burns)
TYPES LOWER SEGMENT TRANSVERSE CAESAREAN SECTION
DEFINITION
Commonly referred to as a low transverse uterine incision and a pfannenstiel skin incision is
made horizontally across the abdomen just over the symphysis pubis and also horizontally across
the uterus just over the cervix.

ADVANTAGES
● Results less blood loss due to less vascularity
● Easier to suture, Healing is better
● Decreases postpartum uterine infection
● Is less likely to cause postpartum gastrointestinal complications
● Chances of rupture during subsequent pregnancy / labour are less

DISADVANTAGES
● Takes longer to perform
● In a few instances the skin incision is made horizontally and then the uterine incision is made
vertically or vice versa.

UPPER SEGMENT CESAREAN SECTION DEFINITION

In upper segment cesarean section, the incision is made vertically through both the abdominal
skin and the uterus. The incision is made high on the uterus, so that it avoids cutting a possible
placenta previa.

ADVANTAGES
• It is easier and faster
DISADVANTAGES
• More blood loss (thick and vascular site)
• Difficult repair (thick uterine wall)
• Relative increase in subsequent rupture (4%)

PROCEDURES Pre-operative
• Pre-operative evaluation o Obtain health history- to make assessments and decisions for safety
of the procedure and the use of the anesthesia - Any past surgeries
- Secondary illness
- Allergies to foods or drugs
- Reactions to anesthesia
- Bleeding problems or current medications to help establish surgical risk
- Any body piercings that need to be removed
● Pre-operative interview
- what the procedure will entail
- length of hospitalization anticipated
- if she’s been told about any post-surgical equipment to be used (indwelling
catheter/intravenous fluid line)
- any special precautions that are being planned for her infant such as high-risk nursery care.
● Documentation of fetal status, presentation and lie, and maturity by ultrasound assessment.
● Assessment of circulatory and renal function
● Vital sign determination
● Examination and assessment of Urinalysis, CBC, coagulation profile (prothrombin time,
partial prothrombin time), serum electrolyte and pH, blood typing and cross-matching.
● Explaining the procedure to be done
● Valid informed consent
- Act as witness to a mother’s signature and be certain that it was informed consent ● Overall
hygiene
- provide clean hospital gown
- tie hair, put surgical cap
- remove nail polish, jewelry,contact lenses,lip or mouth piercing, or hair ornaments before
surgery
● Gastrointestinal tract preparation, Stomach should be empty
-administer gastric emptying agent as ordered such as metoclopromide 10 mg IV half to one hour
before the procedure, to speed stomach emptying or a histamine blocker such as ranitidine
50 mg IV half to one hour before the procedure, to decrease stomach secretion may be
prescribed prior to procedure.
-oral antacid such as citric acid and sodium citrate which act to neutralize acid stomach
secretions may be prescribed prior to procedure.
● Baseline intake and output determination, bladder should be catheterized.
● Hydration, IV fluid line begun before surgery
● Patient chart and presurgical checklist, documentation of nursing care until the time a woman
leaves the nursing care unit or labor room must be completed before a woman leaves for the
surgical suite. ● Transport to surgery

Intra-operative
● Administration of anesthesia -
Equipments:
✓ Surgical gloves
✓ 5ml syringe; 18G drawing-up needle ✓ Lidocaine 1% or 2% ✓
Swabs/Cherries soaked in: - Cleanser
- Alcohol
- Povidone Iodine 5%
✓ Swab-holding forceps
- Mother in left lateral tilt position or fetal position
- Pillow 15cm high x 25cm wide x 25cm long beneath right hip, or table tilted 15° to the left) -
Asepsis of the insertion point
- Puncture at the L4-L5 interspace
● Skin preparation
- Cleanser
- Alcohol
- Povidone Iodine 5%
● Insertion of Indwelling Foley Catheter
● Oxygen inhalation via mask
● Placement of drapes around the incision area so that only the small area of the skin is exposed
● Surgical incision
-position the patient
-screen is placed at shoulder level and covered with sterile drape.
-incision area is scrubbed with antiseptic
-drapes placed around the area of incision
-sponge and instrument counts
● Birth of the baby
-cord clamping and cutting between 1-3 mins after birth
-suction newborn’s mouth and nose
-oxytocin administered
-introduction of the newborn, early breast feeding
● Placental delivery
✓ Inject the mother with 5 IU oxytocin IV and 5 IU after placenta expulsion ✓ Check that there
is no active bleeding of large vessels.
✓ Ensure haemostasis of the uterine wound edges with abdominal compresses.
✓ Check the integrity of the placenta and membranes.
✓ Perform systematic uterine cleaning.
● Uterine closure

Post-operative
● The mother will be transferred by stretcher from the OR table to the post anesthesia care unit ●
Administer Antibiotics ANST, as per hospital policy
● Pain relief as ordered
● Care of the bladder
● Monitor
- Vital signs q 15 min for the 1st hour until stable, q 30 min (2nd hour) then 1 hour (3rd hour)
[Pulse, blood pressure, temperature, respiration, pallor]
- Uterine fundus and blood loss
- Urine colour and output
- Pain (Use a pain rating scale to allow the mother to rate her pain)
● Palpate the uterine fundus
- Location
- Consistency
● Encourage early breast feeding
● Promote skin to skin contact with the mother and baby ● Recovery room discharge to the ward
:
✓ When the patient is fully awake
✓ When BP AND heart rate are stable
✓ When vaginal discharge is minimal, and the uterus remains well contracted. ● IV infusion
● Oral fluids after 24 hrs
● Discharge from hospital after 96 hrs
● Stitch removal on 7th post-operative day
● To avoid exertion for 4 – 6 weeks
● Contraceptive advice

Complications associated with cesarean sections in the mother

● Pulmonary embolism
● Bowel/bladder damage
● Hemorrhage
● Sepsis
● Anesthetic complications
● Late
-Incision hernia
-Problems in future pregnancies:
o Scar rupture
o Repeat cesarean

Complications associated with cesarean sections in the baby

● Fetal injury (fetal laceration of 2%)
● Respiratory distress syndrome
● Neonatal depression due to anesthesia

NURSING MANAGEMENT
● Health education
- If spinal anesthesia was used, the woman’s legs are fully anesthetized so she cannot move
them.
- Early ambulation, the most effective method to relieve gas pain.
- Should not take acetylsalicylic acid or aspirin because this can interfere with blood clotting and
healing.
- It is normal not to have bowel movements for 3 to 4 days postoperatively, especially if there is
enema administered before surgery.
● Assess airway, V/S, cardiac monitoring, LOC, fluid and electrolyte, GI system, discomfort and
pain
● Assess the level of consciousness, breath sounds, respiratory effort, oxygen saturation, blood
pressure, cardiac rhythm, and muscle strength (Aldrete’s scoring system)
● Maintain patent airway
● Prompt pain control
● Assessment of the surgical site and drainage tubes
● Monitoring the rate and patency of iv fluids and iv access
● Assessing the patient's level of sensation, circulation, and ensure safety.
 ANESTHESIA

• For an epidural anesthesia, a small area on your back will be numbed with the injection
of a local anesthetic. Then a physician anesthesiologist inserts a tiny tube called a catheter
through a needle inserted in the epidural space lower back. The needle is removed and the
catheter left in place so anesthesia medication can be delivered through this tube as needed, to
numb the entire abdomen for surgery. Although there is no pain, there may be a feeling of
pressure as the needle is being inserted.
Epidural medications, such as bupivacaine, tetracaine, chloroprocaine, or lidocaine. They are
often delivered in combination with opioids or narcotics such as fentanyl and sufentanil
in order to decrease the required dose of local anesthetic.
• For a spinal block(subarachnoid), a physician anesthesiologist injects medication into
the spinal fluid through a needle inserted in the lower back. After the medication is administered,
the needle is removed. The relief from pain is immediate and lasts from an hour and a half to
three hours. You will be numb from your abdomen to your legs and feel no pain. Ex.
bupivacaine
• General anesthesia is the only pain relief method used during labor that makes you lose
consciousness. You will not be awake for the birth of your baby. With general anesthesia, your
baby may be exposed to some of the medications before delivery. Example Propofol, etomidate,
and ketamine are the intravenous (IV) sedative-hypnotic agents commonly used to induce
general anesthesia while adjuvant agents (eg, fentanyl, sufentanyl, morphine, midazolam) are
often used to supplement the effects of the primary sedative-hypnotic induction agent