Sectio Caesarea

Preceptor : dr.Eddi Junaidi,SpOG,SH,M.Kes By : David Rizki Akhirul Zamril

Prologue
Cesarean delivery is defined as the birth of a fetus through incisions in the abdominal wall (laparotomy) and the uterine wall (hysterotomy). According (Mochtar, 1998) Cesarean delivery is defined as the birth of a fetus with incisions in the the uterine wall (hysterotomy) through abdominal or vagina wall. This method had to be done to prevents maternal and fetal death caused by complication that can be acquired if the labor of the fetus through normal delivery

Epidimiology
In indonesia birth rate with sectio caesarea in 12 teaching hospital ratio is between 2,1%11,8%. In sanglah denpasar hospital sectio caesarea within 10 years (1984-1994) 8,06%20,23%

Indication Sectio Caesarea in advance Country

Sectio Cesarea every 100 birth Indication Norwegia Distosia Has been sc before Breech position Fetal distress others Sectio Caesarea 3,6 1,4 2,1 2,0 3,7 12,8 Skotlandia 4,0 3,1 2,0 2,4 2,7 14,2 Swedia 1,8 3,1 1,8 1,6 2,4 10,7 USA 7,1 8,5 2,6 2,2 3,2 23,6

Indication of Sectio Caesarea

passage, passenger , power , mother pshycology Problems??? normal labor and birth risked for fetal and maternal death Mother indication :
Age Pelvic volume History sectio caesarea delivery before Obstacle of birth passage Abnormal contration of the uterus Premature membran rupture Afraid of the pain

Fetal indication

fetal distress Makrosemia Breech position Plasenta Factor : plasenta previa, solution plasenta, plasenta accreta Abnormalty of the umbilical cord : umbilical cord prolaps, umbilical cord strangle

Contraindication of Sectio Caesarea

principaly sectio cesarea delivery is done for mother and fetal safety so in obstetric way there is no contraindication for sectio caesarea delivery for an emergency situation

Classification
Transperitoneal profunda Sectio cesarea
surgery done by doing incision ln the lower segment of the uterus

Classical Sectio cesarea(corporal)

The incision is in the upper segment of the uterus or in the corpus uteri

Vaginal Sectio cesarea

Surgery on the anterior vaginal wall through to uterus cavity

Ekstraperitoneal Sectio cesarea

Sectio operation without peritoneum incision done by pushing the peritoneum layer into the cranial and vesica urinaria into caudal or midline and then open the uterus by doing incision in the lower segment

Sectio Caesarea Technic

Classical Sectio Caesarea (corporal)

Benefit :

Faster fetal delivery Doesnt cause complication such as retraction of the vesica urinaria The incision can be prolonged to proksimal or distal area

Lost

The infection can easily speard through intra abdominal because there is no good reperitonealisation process Increased rate for spontaneous uteri rupture on the next labor

Transperitoneal Profunda Sectio Caesarea

Benefit :
Wound suturing much easier Wound closure with reperitonealisation Peritoneal overlapping is pretty good to hold the spreading of the uterus composition to peritoneum cavity Less bleeding There is lower chance of the spontaneus uteri rupture Compare with the classical way

Lost

Higher rate of vesica urinaria negative symptom

Complaction of the Sectio Caesarea

Severe sepsis Tromboemboli attack Damage in tractus urinarius Infection on the wound Bleeding

Post Operation Sectio Caesarea Care

Wound care of the incision area Post operation instalation care Fluid and nutrition balance Pain management Mobilisation