Indications and Determinants of Cesarean Section: A Cross-Sectional Study
Affiliations.
- 1 Department of Obstetrics and Gynaecology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
- 2 Department of Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
- PMID: 33376704
- PMCID: PMC7758786
- DOI: 10.4103/ijabmr.IJABMR_3_20
Background: Cesarean section is one of the most commonly performed surgeries in obstetric practice for saving the lives of women and their newborns from pregnancy- and childbirth-related complications. Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections.
Materials and methods: This was a hospital-based cross-sectional study conducted at a tertiary care center from April 2019 to September 2019. A quantitative tool was designed to capture all the relevant information regarding sociodemographic factors, obstetric characteristics, and indications of cesarean section among the pregnant women delivering at the tertiary care center.
Results: A total of 150 women with cesarean deliveries were included in this study. The percentage of primigravida women was significantly higher among emergency than elective cesarean section (χ 2 = 28.19, P = 0.0001). Majority of the women were illiterate or had primary education in emergency cesarean section than elective (χ 2 = 44.9691, P = 0.0001). Majority of the women with no or only one antenatal visit underwent emergency than elective cesarean sections (χ 2 = 42.2195, P = 0.0001). Those females who presented with previous Lower Segment Cesarean Section (LSCS) had greater chances of elective cesarean section, and it was statistically significant ( P = 0.004).
Conclusion: The increase in cesarean section rate causes burden to the general health system and also strain on the family members. Hence, caution should be exercised in decision-making to perform cesarean section, especially for primigravida, and a comprehensive evidence-based approach needs to monitor the indication of cesarean section.
Keywords: Cesarean section; determinants; elective; emergency.
Copyright: © 2020 International Journal of Applied and Basic Medical Research.
Nursingofficer
Cesarean Section Indications Nursing Care for LSCS Operation
Definition of Cesarean Section ;
It is a surgical procedure usually after the end of the 28th week of gestation made an incision
through the abdominal wall and uterus wall to deliver the fetus through the abdominal wall. It is on Operative procedure
Routine Cesarean section delivery is not recommended
The pregnant mother who has complications in the Progress of Labour or Pregnancy is not permitted
to give birth from Normal Labour or Vaginal Delivery,
The delivery of Viable fetus through Incision in abdominal wall and uterus
Classification of LSCS
1- Immediate threat to the life of woman or Fetus,
2- Maternal or fetal compromise but not immediately life-threatening,
3 – Needing early delivery but no maternal or fetal compromise,
4 – At a time to suit the woman and cesarean section team
Robson Classification for Cesarean section
Group-1 Nulliparous with single cephalic pregnancy, >_37 weeks gestation in spontaneous labor
Group-2 Nulliparous with single cephalic pregnancy,>_37 weeks gestation who either had labor indicator were discovered by Cesarean section before labor,
Group-3 Multifarious without a previous uterine scar, with single cephalic pregnancy, >_37 weeks gestation in spontaneous labor,
Group-4 Multiparous without a previous uterine scar with single cephalic,
pregnancy, >_37 weeks gestation who either had labor induced or were delivered by cesarean section before labor,
Group-5 All Multiparous with at least one previous uterine scar, with single cephalic pregnancy, >_37 weeks gestation,
Group-6 All Nulliparous women with a single breach pregnancy,
Group -7 All Multiparous women with a single breach pregnancy including women with previous uterine scars,
Group-8 All women with Multiple pregnancies, including women with previous uterine scars,
Group-9 All women with single pregnancy with a transverse or oblige lie, including women with previous uterine scars,
Group-10 All women with single cephalic pregnancy < 37 weeks gestation, including women with previous scars,
Indications for cesarean section
1. Cephalo – pelvic disproportion(CPD),
2. Abnormal lie,
3. Abnormal presentation: breech or transverse, oblique,
4. Abruptio placenta,
5. Adherent placenta,
6. Placenta praevia,
7. cord prolapse/presentation,
8. Failure induction,
9.Failure to progress,
10. HELLP syndrome,
11. Higher-order multiples(triplets or more),
12. HIV Positive,
13. IUGR, Doppler compromise,
14. Maternal request,
15.Others(mention),
16.Pelvis tumors as a contraindication to delivery,
17. Bad obstetric history,
18. presumed fetal compromise,
-Abnormal CTG,
-Meconium stained liquor,
-Abnormal CTG + Meconium stained liquor,
19. Previous preterm cesarean section/hysterectomy/myomectomy,
upper segment cesarean section.
20. Previous uterine surgery (other than CS),
21. Rh ISO immunization,
22. Suspected scar dehiscence,
23. Twin pregnancies (Non-cephalic),
24. Two previous Lscs or more,
25. Vaginal lesion/infection as contraindication vaginal delivery
Preoperative Assessment for C- Section
History collection about past and present Medical-Surgical, obstetrical history,
Check Obstrectrician orders, complete documentation process i.e, a Consent form signed
Assess knowledge of mother about C Section procedures,
Monitor Maternal and Fetal Vital Signs,
Identify Drug allergies,
Labour Status
Uterine Contractions, Frequency, Duration, Intensity,
Vaginal Discharge – Bloody Show, Amniotic fluid Clor, and odor,
Vaginal Changes Dilatation, effessment,
Descent of fetus – presentation, Station, Position,
Abdominal Examination
Assess bowel sounds, Assess fundal height,
Preoperative Diagnostic Procedures for C Section
USG Abdomen,
Haemoglobin Percentage,
Blood Group and Type,
Deferential Count,
Serum Creatinine,
Blood Urea,
Serum Electrolytes,
Hepatitis B,
Urine Sugar,\Urine Albumin,
Preoperative Measures for Cesarian Section
Prepare mother for C Section in the operating room,
Check for Identification data,
ID bracelet correct,
Check for proper documentation and doctors orders,
Diagnostic procedures
Check Status of NBM before surgery,
Skin Preparation, Remove all jewelry
Dress in operating room gown, Insert Intra Cath for IV infusion line,
Nursing responsibility in C Section
Check the mother’s vitals and fetal heart rate,
Support and assist in maintaining the positioning of the patient during anesthesia
Support mother until time baby birth and complete procedure,
Assist neonatal care at birth , during resuscitation, and Newborn Examination,
APGAR Score,
Ensure name ID bracelets are checked, mother and Newborn baby
Establish bonding mother and child interaction and skin to skin contact,
Weight the baby,
Keep baby in a warm towel,
Complete documentation of the procedure,
Preparation of Articles for LSCS
Obstrectical General Tray,
Towel Pack,
Surgical and Medical supplies,
Intra Operative Measures for Cesarian Section
LSCS Surgery Steps
Peri-Operative Preparation,
Delivery of Head and Trunk,
Placenta and Membranes,
Nursing Diagnosis
Anxiety – Anxiety related to cesarian delivery, Pain-related to surgical procedure, Risk for Infection – related to traumatized tissue, Deficient knowledge- Lack of exposure to C Section
Post Operative care for C Section
The mother and child condition is assessed in the post-operative ward or OT recovery room
Asses for the level of consciousness, Record vital signs Blood Pressure, Pulse Rate, Respiration, Temperature, SPO2 Level every 15 mins up to two hours, Check for the Doctors orders, for the previous analgesia administered, Assess Level of pain and a prescription for further, Check for the potency of a urinary catheter, color and amount of urine, Assess for wound site for ooze, Discharge amount of lochia,
Should be maintained Optimum ventilation and hemodynamic status
Encourage deep breathing and coughing exercises, Leg exercises and Begin ambulation within 6-12
Provide skin to skin contact mother and baby to preventing hypothermia, and developing bonding between baby and mother, Encourage and assist in breastfeeding
after surgery, if prescribed for oral and diet, introduce sips of water to mother, Introduce liquid and diet as prescribed,
Give Health education about personal hygiene and perineal care,
Teach mother about newborn care and importance of immunization,
Counsel the couples for family planning methods,
Complications during Delivery or Cesarian operation
Intrapartum for Vaginal delivery Complications to the Mother 1. Amniotic fluid embolism, 2. Hematoma, 3. Perineal laceration, 4. Placental abnormalities (Abruptio, Accreta, Retainers placenta), 5. Preeclampsia, 6. Prolonged labor, 7. Obstructed labor, 8. Uterus Abnormalities (Ruptured uterus, Uterine atony, Inversion, or uterus), 9. Unplanned hysterectomy, Complications to the baby, 1. Birth Asphyxia, 2. Birth injury, 3. Cord Prolapse, 4. IUFD (Intra Uterine Fetal death), 5. Meconium aspiration syndrome, 6. Shoulder Dystocia,
Intra-operative Complications to the Mother
1. Blood clots, 2. Disruption of uterine arteries, 3. Excessive blood loss(Hemorrhage), 4. Hysterectomy, 5. Incidental surgical injuries-Lacerations, abrasions, and scarring, 6. Placenta accreta, 7. Pelvic organ injuries: Uterine, Urethral, bladder, and bowel injuries, 8. Uterine atony and hypotonia,
Complications to the baby
1. Birth Asphyxia, 2. Erb’s Palsy, 3. Incidental surgical Injuries-Lacerations, abrasions, and scarring, 4. Intracranial Hemorrhage,
Complications of Cesarean Section
Hemorrhage. Bladder Injury, Urethral injury, Castro Intestinal Injury, Infection, Wound Complications,
DVT Deep Vien thrombosis,
chronic Pelvic Pain or Backache,
Incisional Hernia,
Intestinal Obstruction due to adhesions and bonds,
C Section Complication After at Future pregnancy,
Scar dehiscence, Scar Rupture,
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Sep 21, 2019 • Download as DOCX, PDF •. 30 likes • 17,880 views. V. vaibhavsharma19871987. Case presentation on previous two cesarean section. Health & Medicine. Slideshow view. Download now. Case presentation of previous two cesarean section - Download as a PDF or view online for free.
A lower ( uterine) segment Caesarean section ( LSCS) is the most commonly used type of Caesarean section. [1] Most commonly to deliver the baby a transverse incision is made in the lower uterine segment above the attachment of the urinary bladder to the uterus. This type of incision results in less blood loss and is easier to repair than other ...
Results: A total of 150 women with cesarean deliveries were included in this study. The percentage of primigravida women was significantly higher among emergency than elective cesarean section (χ 2 = 28.19, P = 0.0001). Majority of the women were illiterate or had primary education in emergency cesarean section than elective (χ 2 = 44.9691, P = 0.0001). ). Majority of the women with no or ...
The objectives of our study are: 1. To have an overview of fetomaternal indications for LSCS at a teaching hospital. 2. To review intra-operative and post-operative complications of LSCS at tertiary care centre. Study Design A retrospective study Study Period From January 2009 to December 2010 MATERIAL AND METHODS
A study in the United Kingdom showed that the rate of caesarean section has increased from 12.5% in 1990 to 18.3% in 1999, while in China, ... A case series of 25 patients in the United Kingdom has described the use of spinal anaesthesia in category-1 caesarean section. While case selection is important, anaesthesia can successfully be ...
Case studies in women's health. Maureen Gardiner, Lauren Guthrie, in Clinical Case Studies in Physiotherapy, 2009. HPC. Patient admitted to a post-natal ward following an emergency lower segment caesarean section (LSCS) after a trial of forceps the previous afternoon at 39 weeks' gestation
case study: Lower Segment Caesarean Section - Free download as PDF File (.pdf), Text File (.txt) or read online for free. Lower Segment Caesarean Section
lower segment caesarean section (LSCS). Compared with epidural technique, spinal anesthesia is quicker and easier to perform, with a definite end point, and a high success rate. It produces rapid, dense and predictable block especially with hyperbaric solutions. There is minimal risk of regurgitation and aspiration of gastric contents.
During the study period, there were 9500 deliveries in our labour unit including 3760 LSCS (39%). A total of 480 cases (66 of emergency and 414 urgent indications) fulfilling the inclusion criteria were taken into study. The mean birth weight was 2.68 kg (2 SD ± 0.58), and low-birth-weight neonates were 18.33%.
Those females who presented with previous Lower Segment Cesarean Section (LSCS) had greater chances of elective cesarean section, and it was statistically significant (P = 0.004). Conclusion: The increase in cesarean section rate causes burden to the general health system and also strain on the family members. Hence, caution should be exercised ...
Key content The incidence and presentation of complications of caesarean section. The surgical management of intrapartum and postpartum haemorrhage. Risk factors for, and prevention and treatme...
Results: In our study, incidence rate of patients with previous two LSCSs was 5% (192 of 4087 patients). Among the cases with previous two LSCSs, placenta previa was observed in 6% of our patients. Two percent of our patients had abnormal placentation. Around 28% of our patients had severe adhesions with advancement of the bladder, 15% of our ...
Classification of LSCS. category. 1- Immediate threat to the life of woman or Fetus, 2- Maternal or fetal compromise but not immediately life-threatening, 3 - Needing early delivery but no maternal or fetal compromise, 4 - At a time to suit the woman and cesarean section team. Robson Classification for Cesarean section.
Case presentation post caesarean pregnancy. Aug 20, 2015 • Download as PPTX, PDF •. 115 likes • 43,812 views. Y. ymadhu326. this is a case presentation and discussion of post caesarean pregnancy. Health & Medicine. 1 of 50. Download now.
However, in other studies it was the second leading cause.4,6,11,17 Previous CS is second leading indication in this study (19.7%) which is similar to the findings of Moges et al andDhakal et al ...
The WHO stated, on the basis of a study of maternal and fetal complications between 2004 and 2008 in 24 countries, ... Larsson C, Kallen K, Andolf E. Cesarean section and risk of pelvic organ prolapse: a nested case-control study. Am J Obstet Gynecol. 2009; 200 (243):e1-e4. [Google Scholar] e114.
Results: The prevalence of LSCS was 45.84%. Out of the 381 LSCS performed, 44% were emergency cases and 56% were elective. Previous LSCS was the most common indication (153 cases, 42.5%), followed by failure of induction of labor (92 cases, 24.13%). Conclusion: Indications for LSCS are common in most institutions globally.
delivered through LSCS delivery on 17-05-2019 with birth weight 3.2 kg at 39th week of gestational age. Baby was cried soon after birth, No any congenital anomalies ... through Ayurveda - A Case Study International Journal of Health Sciences & Research (www.ijhsr.org) 487 Vol.9; Issue: 8; August 2019 neonatal jaundice.
The mean age among cases of elective LSCS is 25 years. The mean age among cases of emergency LSCS is 24 years. Anemia (26.77%) and preeclampsia (25.19%) are the most commonly associated risk factors for SSI. The causative organisms for wound infection in cases of lower segment cesarean section at wound site is studied in detail for the ...