Cesarian section update

Postoperative analgesic formula: 12mg butorphanol tartrate, 9mg granisetron hydrochloride, diluted with normal saline to ml. Background dose: 2 milliliter per hour, patient controlled analgesia PCA : 0. Samples Collection and Analysis For blood gas analysis and the plasma dexmedetomidine concentrations:.

Maternal venous blood samples MV , umbilical artery UA and umbilical vein UV will be collected for blood gas analysis, plasma dexmedetomidine concentrations.

Followed with 0. The placebo and the dexmedetomidine solutions will be looked identical and their infusions will be continued until skin closure.

Diastolic blood pressure of Dexmedetomidine in Epidural Anaesthesia [ Time Frame: before anesthesia, infused 10 min, at the delivery of the baby, at the end of the operation ] identifying the effects of 0. Saturation of pulse oxygen of Dexmedetomidine in Epidural Anaesthesia [ Time Frame: before anesthesia, infused 10 min, at the delivery of the baby, at the end of the operation ] identifying the effects of 0. Heart rate of Dexmedetomidine in Epidural Anaesthesia [ Time Frame: before anesthesia, infused 10 min, at the delivery of the baby, at the end of the operation ] identifying the effects of 0.

Placental Transfer of Dexmedetomidine in Epidural [ Time Frame: at the delivery of the baby ] identifying the effects of 0. When the baby was born, we double clamped the umbilical cord,and extracted 3ml blood from the maternal vein MV on the no venous route hand, umbilical artery UA and umbilical vein UV from the isolated placenta. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision.

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Search for terms. Save this study. Warning You have reached the maximum number of saved studies Dexmedetomidine for Cesarean Section The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Last Update Posted : March 28, Study Description. Current cesarean section often chooses spinal anesthesia.

However, the majority of puerperas would appear nervous, anxiety, fear and other psychological reactions in cesarean section. Search Health Topics. Search the NIH Guide. NIH Research Matters. February 9, Restoring microbes in infants born by cesarean section. Larger studies with further follow-up will be needed to determine the long-term health consequences of the microbial transfer procedure.

Researchers enriched the microbes of babies delivered by C-section to levels more typical of babies born vaginally. The health impacts remain to be studied. At the head of the surgical table is the anesthesia equipment, which includes monitors for patient vital signs, organizational cabinets, medications for achieving adequate anesthesia, and airway equipment.

Even though cesarean deliveries usually take place with a regional anesthetic, general anesthesia can be necessary. This tray contains the surgical instruments traditionally used during the procedure and may vary by region or hospital. This tray may include several kinds of scissors bandage, Metzenbaum, straight and curved Mayo , several kinds of clamps Kelly, Kocher, Allis, Babcock , sponge forceps, several kinds of tissue forceps Adson, Russian, Ferris Smith, smooth , retractors bladder blade, Army Navy, Richardson , knife handles, needle drivers, suction Yankauer or Poole , or other instruments.

The availability of a standardized surgical pack and cesarean instrument tray can be beneficial. For example, if an emergency cesarean is needed, this will mitigate the time-consuming need to gather appropriate equipment.

In addition to standard instrument trays for the cesarean section, a hysterectomy instrument tray should also be available. A peripartum hysterectomy is relatively rare, but it is becoming more common. Having the appropriate instruments readily accessible can save precious time in an emergency.

Before any surgery is possible, the patient should have analgesia. Except for rare emergencies, the anesthesia team will provide this. In some institutions, obstetric anesthesia is the responsibility of a dedicated team.

In others, anesthesia providers care for patients in all surgical suites, including the main operating room and the labor floor. If the administration of additional medications or blood products is necessary or blood needs to be drawn for laboratory testing, it is the anesthesia staff that often performs these tasks.

The primary surgeon during a cesarean may vary by hospital and region. In other hospitals, especially in rural settings, a general surgeon may be the one performing cesarean sections. Family practitioners who practice obstetrics may also perform cesarean sections. It may be another physician, such as a practice partner or an obstetric hospitalist.

It may be a trained nurse or a certified nurse-midwife. It could be a resident physician or fellow. The circulating nurse is a non-sterile member of the team. As such, he or she can retrieve additional equipment or supplies that may be needed. He or she can chart or document as indicated and play a role in the safety of the patient. The circulating nurse often works in conjunction with the scrub nurse to ensure that counts of surgical instruments, needles, and sponges are correct.

A nurse, nurse practitioner, or physician can assume care of the neonate after delivery. If the neonate is expected to be significantly preterm or need specialized care birth defects, drug exposures, etc. This care may include nurse practitioners or physicians from the neonatal intensive care unit. In some practice settings or scenarios, the primary surgeon or anesthesiologist may be called upon to assist in the care of the newborn.

According to enhanced recovery protocols, prenatal care should include educating patients and their partners about the possibility of cesarean delivery.

The patient should receive information about what to expect before, during, and after the procedure. If a cesarean delivery is anticipated, perhaps due to maternal or fetal complications, any maternal comorbidities anemia, diabetes, hypertension, obesity should be optimized preoperatively if possible. There is an aspiration risk with subsequent pneumonitis with cesarean delivery. Preoperative antacids sodium citrate and a histamine H2 antagonist can be administered to prevent low gastric pH.

Most recently, enhanced recovery protocols have recommended the patients be encouraged to drink clear liquids until 2 hours before the scheduled surgery, and solid food is prohibited for 6 hours prior. Additionally, carbohydrate fluid supplementation may be offered to nondiabetic patients up to 2 hours before surgery, which may also improve patient outcomes. Oral or mechanical bowel preparation is not recommended.

In the case of emergencies, NPO status may be superseded by urgent fetal or maternal indications. Preoperative gabapentin has been found to improve pain control after cesarean delivery.

As with any surgery, the cesarean section carries a risk of infection. It is considered a clean-contaminated surgical wound due to the contiguous nature of the uterus, cervix, and vagina.

Cesarean section is the most important risk factor for a woman developing an infection in the postpartum period.

Women who have a cesarean are at 20 times greater risk of infection than women who have a vaginal delivery. Antibiotics should have coverage for gram-positive and gram-negative bacteria, as well as some anaerobes. A single intravenous dose of 1 g of cephazolin is routine for women weighing less than 80kg, and the dose increases to 2 g for patients weighing 80 kg or more. For women weighing kg or more, there is a consideration for increasing the dose of cephazolin to 3 g to achieve adequate tissue concentrations of the antibiotic.

An allergy merits significant consideration if evidenced by urticaria, respiratory distress, angioedema, or anaphylaxis. The addition of a single dose of vancomycin is recommended in patients with a history of methicillin-resistant Staphylococcus aureus. Because of the nature of the cesarean section, infection risk is conferred by vaginal flora in addition to skin flora.

Women undergoing cesarean after labor or rupture of membranes have increased exposure to vaginal bacteria. More recent research has found that, for these women, the addition of mg of azithromycin intravenously to traditional antibiotic prophylaxis is beneficial for reducing infectious morbidity.

Topical preparations have also been utilized to decrease infection after cesarean. Topical povidone-iodine and chlorhexidine have both been found to be effective for abdominal skin preparation. Research is mixed and of generally low quality; however, there may be some evidence that chlorhexidine is superior to povidone-iodine in reducing infection.

In addition to abdominal skin preparation, vaginal preparation should also be a consideration. A Cochrane Review recently examined this topic and concluded that vaginal preparation probably does reduce the risk of endometritis after cesarean.

The cesarean section is a complicated procedure. Appropriate tissue handling, adequate hemostasis, avoiding tissue ischemia, and preventing infection are essential for wound healing and reducing subsequent adhesion formation. During the surgery itself, several techniques are utilizable at each step or tissue layer. As with any aspect of medical practice, basing those decisions on evidence is recommended.

Before cesarean, the pubic hair may be removed or not. Those advocating for hair removal claim a decrease in surgical site contamination and infection. However, a Cochrane review did not show lower infection rates with hair removal. Therefore, hair removal should only occur if it provides improved visualization.

If opting for hair removal, it should be with clippers rather than razors. Patients should also be discouraged from shaving their pubic area as they approach their due dates or schedule cesarean dates. Shaving with a razor may cause microscopic skin breaks that are associated with more surgical site infections compared to clipping.

The initial skin incision can be made either in a suprapubic transverse or midline vertical fashion. A vertical midline incision is considered to provide faster access to the abdominal cavity, and it disrupts fewer tissue layers and vessels, leading to many citations as the preferred method to perform an emergency cesarean.

In the case of a planned cesarean hysterectomy for a morbidly adherent placenta, a vertical incision may provide more surgical exposure, as well as access to the hypogastric arteries. However, a transverse skin incision is the most commonly used and is preferable in most cases due to improved wound healing and patient tolerability. Because most clinicians are more adept at low-transverse cesarean entry, this technique is often utilized even in emergency scenarios.

Unplanned cesarean hysterectomies can take place through a low transverse incision. Patient habitus may lead some surgeons to place a transverse skin incision higher on the abdomen, rather than underneath the pannus, though research is not yet definitive on this technique.

A Pfannenstiel skin incision is slightly curved and is located 2 to 3 centimeters or 2 fingerbreadths above the symphysis pubis. The midportion of the incision is within the hair-bearing area of the mons. The hair should be removed in this case.

A Joel-Cohen incision, in contrast, is straight rather than curved. It is 3 cm below the line connecting the anterior superior iliac spines, making it more cephalad than a Pfannenstiel skin incision. The subcutaneous layer is next, and it can be dissected bluntly or sharply. Blood vessels course through this layer, so care should be taken to minimize blood loss by limiting sharp dissection to the midline until the fascia is reached, then bluntly dissecting laterally.

Alternatively, judicious use of cautery can maintain hemostasis if blood vessels are transected. The fascia is then incised in the midline with the scalpel, and this incision is extended laterally either sharply or bluntly. The fascia may then be dissected off the underlying rectus muscles. To accomplish this dissection, both the superior and inferior aspects of the fascia are sequentially grasped with a clamp such as a Kocher , and dissection can be accomplished with a combination of blunt technique as well as sharply using scissors or cautery.

Care is necessary not to damage the underlying rectus muscles. Although, in some clinical scenarios, the rectus muscles may be deliberately cut to provide better surgical access. One small randomized control trial investigated dissection compared to non-dissection of the fascia from the rectus muscles.

Nondissection was associated with a slower decline in hemoglobin levels postoperatively and less pain on a visual analog scale. However, surgical time and difficulty of delivery of the fetus were not evaluated. Therefore, this study may not be sufficient impetus to change surgical technique. After separating the rectus muscles in the midline, entry into the abdominal cavity is achieved by opening the peritoneum. The surgeon can do this either sharply or bluntly. If utilizing sharp entry, care should be taken to avoid injury to underlying structures such as the bowel.

Once the entry is achieved, the peritoneal incision is usually extended bluntly. Care is necessary to prevent injury to the bladder during the extension of the peritoneal incision. A bladder blade is often placed at this point to provide visualization of the lower uterine segment. Alternatively, a self-retaining retractor is an option.

The bladder flap can be created at this point if so desired; the peritoneum overlying the bladder and lower uterine segment is grasped and incised, and the bladder is dissected off the lower uterus sharply or bluntly. Surgeons choosing to create a bladder flap do so out of a desire to decrease surgical injury to the bladder, especially during repair of the uterine incision. Bladder injury is rare, and studies have been underpowered to detect whether the omission of the bladder flap changes the incidence of bladder injury.

With adequate visualization, whether or not a bladder flap has been created, the uterine incision can now be made.

Cesarean delivery: counseling issues and complication management. Am Fam Physician. American College of Obstetricians and Gynecologists. Cesarean Birth: FAQs. March of Dimes. Actively scan device characteristics for identification. Use precise geolocation data. Select personalised content. Create a personalised content profile.

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List of Partners vendors. Cesarean Section Preparation and Anesthesia. Initial Incision This photo contains content that some people may find graphic or disturbing. See Photo. Follow-Up Incisions This photo contains content that some people may find graphic or disturbing.

Suctioning of Amniotic Fluids This photo contains content that some people may find graphic or disturbing. Delivery of Baby's Head This photo contains content that some people may find graphic or disturbing. Delivery of Baby's Shoulders and Body This photo contains content that some people may find graphic or disturbing.

Baby Is Born This photo contains content that some people may find graphic or disturbing. Delivery of the Placenta The next steps are the delivery of the placenta, followed by the suturing of the uterus and all the layers that were cut during the surgery.

Closing the Incision This photo contains content that some people may find graphic or disturbing. A Word From Verywell Many people are nervous, and some are disappointed, about having a c-section, but what matters most is the safe delivery of your baby. Recovery After C-Section. Was this page helpful? Thanks for your feedback! Sign Up.

What are your concerns? Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Related Articles. Understanding Ectopic Pregnancy Surgery.

The Risks of Birth by Cesarean Section. Week 40 of Your Pregnancy.