A.
Definition
Sectio caesarea is surgery to deliver the
fetus by opening the abdominal wall and uterine walls. (Sarwono, 2005)
Sectio
caesarea is a way of delivery of a fetus by making an incision on the front
wall of the uterus through the abdomen or vagina. Histerotomia also called for
the delivery of a fetus from the womb. (Mochtar, 1998)
B.
Etiology
Indications SC:
Classic
indication that can be put forward as the basis caesarea section are:
a) Prolog
neglected labor to labor.
b) Uterine
rupture imminen
c) fetal
distress
d) Large
fetus exceeds 4000 gr
e) antepartum
haemorrhage
(Manuaba,
I.B, 2001)
While the high
number of indications that add sectio deliveries are:
a. Malpersentasi
fetus
1. Location
of latitude
If
there is a narrow pelvis, then sectio caesarea is the way / the best way in the
delivery of a fetus with all the latitude location and the size of normal
living fetus. All primigravida with latitude should be helped with the layout
sectio caesarea although no estimates of narrow pelvis. Multiparous with
latitude location can first be helped in other ways.
2. Location
of the rear
Caesarea
sectio suggested or recommended in the location of the rear when a narrow
pelvis, primigravida, large fetus and valuable.
b.
Placenta previa central
and lateral
c.
Complete presentation
when repositioning was unsuccessful.
d.
Gemeli according to
Eastman, cesarea sectio recommended when the fetus first location latitude or
shoulder presentation, in case of an interior (looking of the twins), dystocia
due to a tumor, fetal distress, and so forth.
e.
prolonged labor
f.
Parturition not advance
g.
Pre-eclampsia and
hypertension
h.
cervical dystocia
C.
Purpose
Sectio Caesarea
The
purpose of doing sectio caesarea (SC) is to shorten the length of the bleeding
and prevent tearing of the cervix and lower uterine segment. Sectio caesarea
performed on placenta previa and placenta previa totalis more if bleeding. In
addition to reducing infant mortality in placenta previa, sectio caesarea also
performed for the benefit of the mother, so sectio caesarea performed on
placenta previa even if the child is dead.
D.
Type
- Type Operations Sectio Caesarea (SC)
a) Abdomen
(Abdominal SC)
1) Sectio
Caesarea Transperitonealis
·
Sectio caesarea classic
or corporal: the longitudinal incision on the corpus uteri.
·
Sectio caesarea deep:
with an incision in the lower uterine segment.
2) Sectio caesarea ekstraperitonealis
Is sectio caesarea without opening
the parietal peritoneum and thus not opening the abdominal cavity.
b) Vagina
(sectio caesarea vaginalis)
According
to the direction of the incision in the uterus, Caesaria sectio be conducted
if:
1) The
incision lengthwise (longitudinal)
2) transverse
incision (transverse)
3) The
incision letter T (T Insisian)
c) Classic
Sectio Caesarea (corporal)
Performed
by making an incision in the corpus uteri extending approximately 10cm.
Advantages:
1) Remove
the fetus is more elongated
2) Does
not cause complications of bladder interested
3) The
incision can be extended proximally or distally
Disadvantages:
1) intra-abdominal
infection is easily spread because there is no good reperitonial.
2) For
subsequent deliveries are more common spontaneous uterine rupture.
Uterine
rupture because the classical SC scars are more common than the SC deep wounds.
Uterine rupture due to scar classic SC can already occur at the end of
pregnancy, whereas in the SC deep scars usually only occur in labor.
To
reduce the possibility of uterine rupture, it is recommended that women who
have experienced the SC should not be too quick to get pregnant again. At -Lack
can rest for 2 years. The rationale is to give the wound healed well. For this
purpose it is installed chord before closing the wound of the uterus.
d) Sectio
Caesarea (Ismika Profunda)
Performed
by making an incision on the concave transverse lower uterine segment is
approximately 10cm
Advantages:
1) Tailoring
wound more easily
2) The
closure of the wound with a good reperitonialisasi
3) Overlap
of peritoneal flap splendidly to hold the contents of the uterus to the
perineal cavity
E. Admitting
patient
1.Collect
the data of name, age, marital status, occupation, and sex
2.Present
complain :
The main complaints:abdominal pain
intensity: moderate to severe
3. On
Examination : Check for the awareness, weight, Blood Pressure, Respiration rate,
Pulse, Temperature, and Saturation of Oxygen
4. general
conditions: pregnant women will typically experience pain in the abdominal
area, pain accompanied with great heartburn.
·
Ear, Nose, Throat : symmetrical eye position,
Normal eyelid, Normal eye movement, Conjunctiva pink, normal corneal, No eye muscle disorders, Good visual
function, Normal earlobe, Normal middle ear conditions, No discharge from the
ear, Normal hearing function, Normal speech system
·
Respiratory
System : breath net, No obstruction, Not blown, Do not use a respirator,
rhythmical, Type spontaneous breathing, Palpation of the breast : not palpable
tactile fremitus, Chest percussion : resonant, Vesicular breath sounds
·
Cardiovascular
System : rhythmical, strong pulse, Blood pressure 120/90 mmHg, There is no
jugular venous distention, Skin temperature is warm, Reddish color, Capillary
refill of 2 seconds, The presence of edema in the upper limbs
·
Central Nerves System
: No headaches, The level of awareness
compos mentis, Normal physiological reflex.
·
Gastro
Intestinal System : No caries, No stomatitis, No dirty tongue, normal Saliva,
not vomiting, any abdominal pain, No diarrhea, No constipation, The liver was
not palpable, flabby abdomen
·
Musculoskeletal
System : Normal.
·
Management :
measuring vital signs , assessing pain scale, gives the position as comfortable
as possible , teach relaxation techniques , CS prosedure.
F. Pre
Operatif
1. Assess
the level of anxiety Ps. (heavy, medium, light)
2. Assess TTV
3. Provide emotional support
4. Teach relaxation techniques (breathing in, imagination etc.)
5. Give the knowledge about the course of the operation section
2. Assess TTV
3. Provide emotional support
4. Teach relaxation techniques (breathing in, imagination etc.)
5. Give the knowledge about the course of the operation section
G. Intra Operatif
·
Assess breathing
pattern ps. (deep, shallow)
·
Monitor TTV
·
Give ps. Position feet lower than the head
·
Give O2 therapy
·
Observation of
bleeding
·
Monitor intake
and output
·
Monitor TTV
·
Collaboration of
the liquid electrolyte (RL, NaCl)
·
Assess the width
of the wound, location of the wound
·
Take action
sterile (disinfectant, use tools, sterile clothes)
H. Post Operatif
·
Instruct the
patient to move their lower extremities
·
Installing the
side barrier bed
I. Recovery Room
in the recovery room the patient will wake up and we need
to help restore the patient is fully conscious. after 2 hours the patient in
the recovery room, make sure there are no complications or postoperative
problems. re-signs monitoring - vital signs. and if there is pain in the wound
given analgesic or pain relief
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