sectio caesarea (english)

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

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