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○ Emergency
Reasons: Placenta previa, abruptio placenta, fetal
distress, failure to progress labor
Effects of surgery to mother:
○ Stress response
Results from release of catecholamine from the
adrenal medulla
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adrenal medulla
□ Epinephrine: increased heart rate, bronchial
dilation, and elevation of blood glucose level
□ Norepinephrine: peripheral vasoconstriction-->>
increased BP
May antagonize the effects of anesthesia which is
aimed at minimizing body activity
Minimizes blood supply to her lower extremities-->>
risk for thromboplebitis
○ Interference with body defenses
Risk for infection because the skin as a primary line of
defense is intruded
Strict aseptic technique should be followed
○ Interference with circulatory function
Extreme blood loss-->> hypovolemia and decreased BP
Blood loss:
□ Vaginal birth: 300-500 ml
□ Cesarean birth: 500-1000 ml
Interference with body organ function
□ Uterus is handled and may not contract
normally-->> postpartum hemorrhage
□ Uterine function, bladder, intestine and lower
circulatory function must be carefully assessed
Interference with self-image or self esteem
□ Scar- lowered self-esteem
Nursing Care: Scheduled/Anticipated Cesarean Birth
○ Operative risk for the woman
Poor nutritional status: vitamin deficiencies
Age variations: age 40 above has lowered circulatory
functioning
Altered general health: presence of secondary illness
could put woman at risk
Fluid and electrolyte imbalance
Fear
Infection
Hemorrhage
Urinary tract trauma
Thrombophlebitis
Paralytic ileus
Atelectasis
Anesthesia compications such as aspiration of gastric
contents
○ Operative risk to newborn
Higher instances of respiratory difficulties because in
vaginal delivery, the newborn's chest is compressed
thus getting rid of lung fluids-->> transient tachypnea
of the newborn
Some newborn develop pulmonary hypertension
Inadvertent preterm birth
□ Greatest risk is lung immaturity
Transient tachypnea of the newborn caused by delayed
absorption of lung fluid
Persistent pulmonary hypertension of the newborn
Injury such as laceration, bruising or other trauma
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Injury such as laceration, bruising or other trauma
○ Preoperative Diagnostic Procedures
Vital signs assessment both mother and fetus (specially
FHR pattern)
Urinalysis
Complete blood count
Coagulation profile (PT, PTT)
Serum electrolytes and pH
Blood typing and cross matching
Sonogram-->> fetal maturation and maturity
○ Preoperative teaching
Aimed at acquainting the woman with the procedure
and any special equipment to be used, allowing her to
be as informed as possible TO REDUCE FEAR
Teaching to prevent complications
□ importance of maintaining good respiratory and
circulatory function in avoiding postoperative
complications
Deep breathing: 5-10 deeps breaths per
hour postoperatively Helps decrease the
possibility of lung infection
Incentive spirometry: blowing
Turning: important to prevent respiratory
and circulatory stasis
Ambulation: stimulates lower extremity
circulation; 4hours after operation
○ Immediate Preoperative Care Measures
Informed consent: woman is informed with risk and
benefits of the procedure in terms that she could
understand
Overall hygiene
Gastrointestinal tract preparation: enema and
medications
□ Medications:
Metoclopramide-speeds stomach emptying
Ranitidine-histamine blocker that decrease
stomach secretions
Sodium citrate and famotidine- oral antacid
to neutralize stomach acid secretions
□ These precautions are necessary because the
woman will be lying on her back during the
procedure posing high risks to esophageal reflux
and aspiration
Baseline intake and output determinations
□ Urinary catheter may be inserted to reduce
anterior bladder size and keep it away from the
surgical field
Be sure that urine is draining because fetal
pressure may reduce the flow of urine
considerably
Hydration
□ IV fluid: lactated Ringer's solution
Ensures that the woman is hydrated and
reduces the possibility of hypotension from
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reduces the possibility of hypotension from
epidural anesthesia
Preoperative medications
Patient chart and Presurgery checklist
Transport to surgery: urge her to lie on her left side to
prevent supine hypotension syndrome
Role of the support person: encourage them also
Nursing Care: Emergency Cesarean Birth
○ Preoperative preparations: vital signs, urinalysis, blood works
○ Immediate preparations: informed consent, application of
elastic stockings, GIT preparation, bladder catheterization, IV
line
○ Document what was thought so that the nurse who will care
postoperatively will be aware of the need for additional
teaching
Intraoperative Care Measures
○ Administration of Anesthesia
○ Skin Preparation
○ Surgical Incision
Nursing Care
Put towel under left Moves abdominal content up
hip and lifts her uterus off the
vena cava
Screen at shoulder Blocks the flow of bacteria
level covered with a from the woman's respiratory
sterile drape tract to the incision site
Block the patient and the
support person's line of vision
to prevent additional anxiety
Scrub abdomen and Exposes only minimal area of
place appropriate skin
drapes a incision area
Types of Cesarean incisions:
□ Decision is based on the fetal presentation and
the speed at which the procedure will be
performed
□ Skin (abdominal wall) incisions:
Classic (I) incision is made vertically
through both the abdominal skin
and the uterus
Made high on the uterus so that
it can be used with a placenta
previa to avoid cutting the
placenta
Leaves a wide scar
Scar could rupture during labor
thus woman will not be able to
have a subsequent vaginal birth
Advantages:
○ Quicker to perform
○ Better visualization of the
uterus
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uterus
○ Can quickly extend upward
for greater visualization if
needed
○ Often more appropriate for
obese women
Disadvantages:
○ Easily visible when healed
○ Greater chance of
dehiscence and hernia
formation
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Murray, et. al. Foundations of
Maternal-Newborn Nursing, 3rd Ed.
Philadelphia: W. B. Saunders
Company
□ Uterine incisions:
Low Preferred type of incision
Transverse Not suitable for a very large fetus
Length of incision is limited
because the uterine artery is and
vein enter the uterus at its lower
right and left sides
The low transverse incision may
not be large enough to deliver a
large baby without tearing these
large babies
Sometimes, a vertical incision
must be added to a transverse
one (making an inverted T) to
deliver a very large baby
Advantages:
○ Unlikely to rupture during a
subsequent birth
○ Makes
○ Makes VBAC possible for
subsequent pregnancy
○ Less blood loss
○ Easier to repair
○ Less adhesion formation
Disadvantages
○ Limited ability to extend
laterally to enlarge the
incision
Low Advantages:
Vertical ○ Can be extended upward to
make a larger incision if
needed
Disadvantages
○ Slightly more likely to
rupture during a
subsequent birth
○ A tear may extend the
incision downward into the
cervix
Classic Vertical incision into the upper
uterus
More likely to rupture during
later pregnancies
Advantages:
○ May be the only choice in
these situations:
Implantation of a
placenta previa on
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placenta previa on
the lower anterior
uterine wall
Presence of dense
adhesions from
previous surgery
Transverse lie of a
large fetus with the
shoulder impacted in
the mother's pelvis
Disadvantages:
○ Most likely of the uterine
incisions to rupture during
a subsequent birth
○ Eliminates VBAC as an
option for birth of a
subsequent infant
Source: Murray, et. al. Foundations of
Maternal-Newborn Nursing, 3rd Ed.
Philadelphia: W. B. Saunders
Company.
□ Sometimes, a skin incision is made horizontally
and then the uterine incision is made vertically or
vice versa
During a future pregnancy, do not assume
that just because a woman has a small skin
incision she will have a small uterine
incision as well
○ Birth of the infant
Retractors- allows good visualization if the uterus and
internal incision
Sterile towels may be placed in the incision to separate
the uterus from other organs
The uterus is then cut and the child's head may be
delivered manually or by application of forceps
Mouth and nose of the baby are suctioned by a bulb
syringe before the remainder of the child is delivered
Oxytocin is administered intravenously by the
anesthesiologist as the child or placenta is delivered
to increase iterine contractions and reduce blood loss
In many instances, the woman's partner can be allowed
to cut the umbilical cord
After full birth, the uterus is pulled forward onto the
abdomen and covered with moist gauze
The internal cavity of the uterus is inspected and the
membranes and placenta are manually removed
If the woman wishes to have a tubal ligation, it can be
done at this time
The uterus, subcutaneous tissue and skin incision can
now be closed
□ Metal staples are used are usually used on the
exterior skin because they leave the least
amount of scarring
Introduction of the newborn
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○ Introduction of the newborn
Once the newborn is determined to be breathing
spontaneously, he or she is shown to the mother and
support person just as is done in vaginal delivery
Breastfeeding is usually delayed until the woman is has
been moved to a recovery room, because
breastfeeding initiates uterine contraction and may
interfere with suture placement
Postpartal Care Measures
○ Women who deliver by cesarean birth have additional care
concern in the immediate postpartal period because they are
not only postpartal patients but postsurgical one as well
○ Due to the strain of the unexpected procedure, they may
have increased difficulty bonding with their new infant
○ There is little time for teaching because of shortened hospital
stays
○ Postpartal phase
Immediate recovery period
Extended postpartal period
Sources:
Pilliteri, Adele. Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family, 4th Ed. Philippines:
Lippincott Williams and Wilkins.
Murray, et. al. Foundations of Maternal-Newborn Nursing,
3rd Ed. Philadelphia: W. B. Saunders Company
Prepared by:
Edward Arlu V. Dinoy CNU-CN 2012
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