Cesarean Section - Preparation, Anaesthesia and Surgery for Cesarean Section

Preparation, Anaesthesia and Surgery for Cesarean Section

Preparation is done as for any major operation -

Blood Tests:

• Hemoglobin, Packed cell volume
• Blood sugar
• Blood grouping
• Thyroid hormone levels

Blood Typing - Blood is typed and cross-matched in case there is excess bleeding and blood transfusion is required.

Urine Test - For detection of protein and sugar in urine some of the basic tests are performed.

Further tests depending on the pregnant woman's condition is also done.

Keeping Them Fasting - The pregnant woman should not have anything to eat or drink for at least six hours prior to the surgery.

Hydration - She will be given medications to reduce the acidity of the stomach and will have an intravenous fluid infusion commenced to maintain the hydration at an optimum level.

Cleaning of Abdomen - The abdomen will be cleaned by means of an antiseptic solution.

Urinary Catheter -A soft tube is passed into the urinary bladder to help the mother to pass urine after the delivery, as she may not be able to move about for the first 24 hours.

Monitoring - The baby’s heartbeat is monitored with the fetal monitor, as are the mother’s pulse, BP and ECG.

Anesthesia

Before any operation, the patient has to be anesthetized so that she does not feel the pain and likewise for a Cesarean section, the anesthesia is administered before the operation.

The anesthesia can be of the following types:

1. General Anesthesia
2. Spinal Anesthesia
3. Epidural Anesthesia

• Spinal Anesthesia is the commonest type of anesthesia used world over because of its ease of administration, safety for the mother and the baby, and early return to normal activities including feeding the baby by the mother.
• Epidural anesthesia is used in situations when it is already in place for a painless labor, or in certain heart conditions wherein an epidural is safer than even a spinal anesthetic.
• General Anesthesia is administered when there are bleeding or clotting problems in the woman which prevent a spinal or epidural or in cases of fetal distress, when there isn't sufficient time to administer spinal anesthesia.

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Surgery of Cesarean Section

Generally, a Cesarean section takes about 45 mins to one hour to perform.

• Once the abdomen has been disinfected by means of an antiseptic solution, it is opened via a curved incision in the lower part of the abdomen, a few centimeters above the pubic hairline. (Bikini incision)
• The muscles over this region are incised and then the uterus is opened at its lower portion. (Hysterotomy). Before the uterus is opened, care in taken not to injure the urinary bladder, which lies very close to the uterus at this point. The bladder is pushed downward and away from the area to be operated.
• Once the uterus has been opened, the waters surrounding the baby are sucked out and then the surgeon passes his hand into the uterus and grasps the “presenting part” of the baby. This is the lowermost part of the baby present within the uterus-it could be the baby’s head or breech, or occasionally its back.

Once the presenting part is within the doctor’s grasp, he gently pulls the baby out. The baby’s mouth is immediately sucked to remove any water it may have swallowed.

• The umbilical cord is then clamped and cut to free the baby from the mother. The baby is wrapped and taken under the pediatrician's care.

The actual delivery of the baby in a Cesarean section is accomplished in about 5 minutes or less to minimize the effect of general anesthesia and surgery on the baby.

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• Meanwhile, the placenta or ‘after-birth’ is then removed from the mother's uterus. The inside of the uterus is wiped clean to remove any bits of placental membrane sticking to it. The opening in the uterus is then stitched up.
• At this point the obstetrician may request the anesthetist to administer medicines to shrink the expanded uterus quickly in size, almost to the pre-pregnancy level. This will ensure that there is less bleeding from the uterus.
• The abdomen is then closed and a sterile dressing is applied over the incision.
• The mother is recovered from anesthesia and moved out of the operating theatre to the recovery room. She is allowed to commence breast-feeding as early as possible.
• After a short stay in the recovery area the mother and baby are shifted to the ward or room.