CESARIAN BIRTH INTRODUCTION: A cesarean section is commonly called a c-section.

Instead of a vaginal birth, during a c-section, your baby is delivered through your abdomen. It is accomplished through an abdominal incision into the uterus and is one of the oldest types of surgical procedures known. It is a procedure always slightly more hazardous than vaginal birth. However, when compared to other surgical procedures, it is one of the safest types of surgeries and one with few complications. DEMOGRAPHIC PROFILE: NAME: AGE: GENDER: CIVIL STATUS: NATIONALITY: ADDRESS: RELIGION: DATE OF BIRTH: ATTENDING PHYSICIAN: DATE OF ADMISSION: FINAL DIAGNOSIS: PATIENT S HISTORY: CHIEF COMPLAIN: For CS HISTORY:

ANATOMY AND PHYSIOLOGY

Mons Pubis : The mons (also called mons venereum or mount of Venus) is the rounded fatty mass over the pubic bone covered with hair and coarse skin. It acts as a buffer during sexual intercourse, preventing injury to the underlying bone. It also contains sebaceous and sweat glands. Some of the latter form a specialized type of gland called the apocrine glands. These glands release a secretion with a characteristic smell that increases sexual attraction. Labia Majora : The labia majora are bilateral folds of skin with underlying fat extending backwards from the mons pubis. They are homologous to the scrotum in males. Posteriorly they merge into the perineum in front of the anus. Their outer surface becomes covered with hair at puberty. But the inner surface remains smooth, moistened by the secretions from the sebaceous and other glands deep inside. The labia majora also contain apocrine glands. Labia Minora : The labia minora are delicate flaps of soft skin which lie within the labia majora. They may be of different sizes in different women and if large enough, may protrude from between the labia majora. Their inner surfaces remain in contact with each other. Anteriorly, they unite to enclose the clitoris between them, forming the prepuce and frenulum from before backwards. The labia minora contaSince the labia are very thin and delicate, they can get torn during labor and childbirth causing heavy bleeding. Bleeding can continue even in the postpartum period and postpartum infections are a common occurance. Vestibule : The vestibule is the part of the vulva lying between the two labia minora. It has two important openings (a) the external urethral opening which is a small slit-like opening just behind the clitoris (b) the vaginal opening which is a larger opening behind the urethral

opening. In virgins, the opening of the vagina is covered by a thin incomplete membrane, called the hymen . Injuries during labor occurs commonly in the vestibular region, especially the paraurethral region. Clitoris : The clitoris is present in the upper part of the vestibule at the point where the two labia minor meet.It is a small cylindrical structure homologous to the penis in males. Like the male penis, it also has a glans, a prepuce and two corpora cavernosa which are attached to the pubic bones. The clitoris is made up of erectile tissue and is richly supplied with nerves, making it the most erotically sensitive part of the body. Bartholin s glands : These are small pea-sized glands situated inside the vestibule on either side of the vaginal opening. They produce a mucoid secretion at times of sexual excitement that help to lubricate the vagina and vulva. Vestibular bulbs : They are embedded in the mucous membrane of the vestibule and are composed of erectile tissue. Perineum : The perineum is the less hairy cutaneous area lying between the vaginal orifice in front and the anus behind. INDICATIONS FOR CESARIAN BIRTH A Caesarian section is a form of childbirth in which a surgical incision is made through a mother s abdomen and uterus to deliver one or more babies. It is usually performed when a vaginal delivery would put the baby s or mother s life or health at risk; although in recent times it has been also performed upon requests for births that would otherwise have been normal REASONS FOR CS INCLUDE: MATERNAL FACTORS y y y y y y y y y Active genital herpes or papilloma AIDS or HIV-positive status Cephalopelvic disproportion Cervical Cerclage Disabling conditions, such as severe hypertension of pregnancy, that prevent pushing to accomplish the pelvic division of labor Failed induction or failure to progress in labor Obstructive benign or malignant tumor Previous cesarian birth by classic incision Elective- no indicated risks

PLACENTA FACTORS y y y Placenta previa Premature separaation of the placenta Umbilical cord prolapse

FETAL FACTORS y y y y y y DRUG STUDY GENERIC NAME INDICATION ACTION CONTRAINDICATION PRECAUTION/ ADVERSE REACTION nausea, vomiting, sweating NURSING CONSIDERATION Should the check the patients name, the correct route, dosage, and frequency of the medicine that should be given Compound conditions such as macrosomic fetus in a breech lie Extreme low birth weight Fetal distress Major fetal anomalies, such as hydrocephalus Multigestation or conjoined twins Transverse fetal lie

Tramadol BRAND NAME: Tramal, Mabron, Ralivia, Ryzolt, Tramacet, Ultracet, Zamadol, Zytram DOSAGE: Adilt:

Moderate to moderately severe pain

Tramadol binds to opiate receptors and inhibits reuptake of norepinephrin e and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to

Health professionals have not yet fully endorsed of its use on a large scale for these disorders, although it may be used when other treatments have failed (under the supervision of a psychiatrist).

pain.