Introduction:
Cesarean section (often called as C-section) delivery is a type of delivery which, is usually done when the health of mother or baby or both, in certain cases, is at high risk or multiple babes are expected to be delivered. Some other factors also govern the selection of Cesarean section over vaginal delivery such as breech or transverse position of baby, dystocia ,fetal distress, failed labour induction, cephalopelvic disproportion, uterine or amniotic rupture, eclampsia, hypertension, tachycardia, macrosomia, due to some disease condition or in rare cases of posthumous birth. [1]Other factors, which drastically affect the recommendation of type of partus, are age of mother and specially the teenage pregnancies, chronic pelvic pain, socioeconomic status, malnutrition, lack of obstetric skills and maternal request without any prior medical reason.[2-5] Obese patients are at higher risk of cesarean section and it’s comorbidity as compared to women with normal weight.[6] Mortality rate associated with cesarean section delivery is higher than vaginal delivery.[7] In cesarean section method, one or more incisions are made through mother’s abdomen and uterus either vertically or horizontally. The incisions are extended by the application of blunt pressure along a cephalad-caudad axis. The baby is then pulled out of the placenta and placenta is removed. Stitches are used to close the abdomen; internal stitches are self dissolving stitches and external stitches need to be removed after one week or more .[8] Once a cesarean delivery is done , a subsequent delivery may be followed by two methods , planned beforehand. …show more content…
Vaginal birth after cesarean section (VBAC) and elective repeat cesarean section (ERCS). There is a myth that if a woman undergoes cesarean delivery in her first pregnancy then she, in her next pregnancy, will definitely undergo cesarean delivery. According to American pregnancy Association, 90% of the women who have undergone cesarean section , in their next pregnancy can give birth to a baby through a vaginal delivery. [9]. Criteria for making VBAC depends upon the previous cesarean sections incision; if the previous incision is transverse then the gynecologist adopts this method. ERCs is elected when multiple gestations are expected, maternal medical complications (such as diabetes), age of the mother is more than 40 years , fetal malpositioning , fetal macrosmia and previous low vertical or unknown incision types. Adverse maternal outcomes of planned or elective cesarean delivery (when compared with planned vaginal delivery) include postpartum risk of cardiac arrest, endometritis, wound hematoma, hysterectomy, major puerperal infection, anesthetic complications, venous thromboembolism and longer stay in hospital [10]. While the fetal outcomes include neonatal respiratory morbidity, hypoxic ischemic encephalopathy, term delivery-related perinatal death. Risk in the future pregnancies significantly increase more in ERCS than in VBAC.[11] There are more risks of placenta accreta, placenta previa, antepartum hemorrhage , uterine rupture, preterm birth, low birth weight or still birth when mother has a previous cesarean history.[12] Patients with placenta previa and scarred uterus have 16% more chances of undergoing cesarean hysterectomy [13]. Antifungal and antibiotics are given before and after the surgery to minimize the chances sepsis and wound infection as postpartum infection is one of the major cause of morbidity.[14] Majorly used antifungal includes Metronidazole, Nystatin, Amphotericin B and antibiotics includes large variety of penicillins and cephlosporins. Studies reveal Cefoxitin has less toxicity and broad spectrum and there is significant reduction in postpartum infection and febrile morbidity.[15] There is no evidence which type of anesthesia is more preferable and superior in terms of …show more content…
Use of antibiotics is found to be impressive in patients who develop the febrile morbidity after cesarean section.[21]
Bradycardia and hypotension occur frequently when the spinal anesthesia is given for cesarean section. To minimize the risk associated with spinal anesthesia, a combination therapy is deployed to combat with the complications. Combination of phenylephrine infusion and crystalloid cohydration helps in prevention of anesthesia induced hypotension in patients undergone cesarean section.[22-24]
Maternal age plays important role in the selection of cesarean section. Elderly primigravida and multigravida increase the chances of cesarean section delivery. [25]Similarly, in nulliparous women, the cesarean rate is found to be elevated as compared to the multiparous women.[26]
Likewise the other surgeries, patients undergone cesarean section also experience the reduced fluid output and catheterization leading toward postoperative urinary retention ( POUR)[27] Urethral catheterization causes bacteriuria. [28] Antibiotics are used prophylactically in case of repeated or prolong catheterization to minimize the chances of catheter induced urinary tract
Cesarean section (often called as C-section) delivery is a type of delivery which, is usually done when the health of mother or baby or both, in certain cases, is at high risk or multiple babes are expected to be delivered. Some other factors also govern the selection of Cesarean section over vaginal delivery such as breech or transverse position of baby, dystocia ,fetal distress, failed labour induction, cephalopelvic disproportion, uterine or amniotic rupture, eclampsia, hypertension, tachycardia, macrosomia, due to some disease condition or in rare cases of posthumous birth. [1]Other factors, which drastically affect the recommendation of type of partus, are age of mother and specially the teenage pregnancies, chronic pelvic pain, socioeconomic status, malnutrition, lack of obstetric skills and maternal request without any prior medical reason.[2-5] Obese patients are at higher risk of cesarean section and it’s comorbidity as compared to women with normal weight.[6] Mortality rate associated with cesarean section delivery is higher than vaginal delivery.[7] In cesarean section method, one or more incisions are made through mother’s abdomen and uterus either vertically or horizontally. The incisions are extended by the application of blunt pressure along a cephalad-caudad axis. The baby is then pulled out of the placenta and placenta is removed. Stitches are used to close the abdomen; internal stitches are self dissolving stitches and external stitches need to be removed after one week or more .[8] Once a cesarean delivery is done , a subsequent delivery may be followed by two methods , planned beforehand. …show more content…
Vaginal birth after cesarean section (VBAC) and elective repeat cesarean section (ERCS). There is a myth that if a woman undergoes cesarean delivery in her first pregnancy then she, in her next pregnancy, will definitely undergo cesarean delivery. According to American pregnancy Association, 90% of the women who have undergone cesarean section , in their next pregnancy can give birth to a baby through a vaginal delivery. [9]. Criteria for making VBAC depends upon the previous cesarean sections incision; if the previous incision is transverse then the gynecologist adopts this method. ERCs is elected when multiple gestations are expected, maternal medical complications (such as diabetes), age of the mother is more than 40 years , fetal malpositioning , fetal macrosmia and previous low vertical or unknown incision types. Adverse maternal outcomes of planned or elective cesarean delivery (when compared with planned vaginal delivery) include postpartum risk of cardiac arrest, endometritis, wound hematoma, hysterectomy, major puerperal infection, anesthetic complications, venous thromboembolism and longer stay in hospital [10]. While the fetal outcomes include neonatal respiratory morbidity, hypoxic ischemic encephalopathy, term delivery-related perinatal death. Risk in the future pregnancies significantly increase more in ERCS than in VBAC.[11] There are more risks of placenta accreta, placenta previa, antepartum hemorrhage , uterine rupture, preterm birth, low birth weight or still birth when mother has a previous cesarean history.[12] Patients with placenta previa and scarred uterus have 16% more chances of undergoing cesarean hysterectomy [13]. Antifungal and antibiotics are given before and after the surgery to minimize the chances sepsis and wound infection as postpartum infection is one of the major cause of morbidity.[14] Majorly used antifungal includes Metronidazole, Nystatin, Amphotericin B and antibiotics includes large variety of penicillins and cephlosporins. Studies reveal Cefoxitin has less toxicity and broad spectrum and there is significant reduction in postpartum infection and febrile morbidity.[15] There is no evidence which type of anesthesia is more preferable and superior in terms of …show more content…
Use of antibiotics is found to be impressive in patients who develop the febrile morbidity after cesarean section.[21]
Bradycardia and hypotension occur frequently when the spinal anesthesia is given for cesarean section. To minimize the risk associated with spinal anesthesia, a combination therapy is deployed to combat with the complications. Combination of phenylephrine infusion and crystalloid cohydration helps in prevention of anesthesia induced hypotension in patients undergone cesarean section.[22-24]
Maternal age plays important role in the selection of cesarean section. Elderly primigravida and multigravida increase the chances of cesarean section delivery. [25]Similarly, in nulliparous women, the cesarean rate is found to be elevated as compared to the multiparous women.[26]
Likewise the other surgeries, patients undergone cesarean section also experience the reduced fluid output and catheterization leading toward postoperative urinary retention ( POUR)[27] Urethral catheterization causes bacteriuria. [28] Antibiotics are used prophylactically in case of repeated or prolong catheterization to minimize the chances of catheter induced urinary tract