ABBR: CS Delivery of the fetus by incision through the abdominal wall and into the uterus. Operative approaches and techniques vary. A horizontal incision through the lower uterine segment is most common; the classic vertical midline incision may be used in times of profound fetal distress. Elective cesarean section is indicated for known cephalopelvic disproportion, malpresentations, and for some patients with toxemia or active genital herpes infection. The most common reason for emergency cesarean delivery is fetal distress.

INCIDENCE
Cesarean section is the most commonly performed major surgery in the world.

COMPLICATIONS
Potential adverse effects on the mother following cesarean delivery include bleeding, fever, abdominal pain, hospital-acquired infection (wound, respiratory, genitourinary), thromboembolic phenomena, paralytic ileus, and wound dehiscence.

PATIENT CARE
Preoperative: The procedure is explained to the patient (and/or her partner) and psychological support is provided. Baseline measures of maternal vital signs and fetal heart rate are obtained; maternal and fetal status are monitored until delivery, according to protocol. Laboratory data, ultrasound results, or the results of other studies are available to the obstetrical team. The operative area is prepared according to the surgeon's preference, and an indwelling urinary catheter is inserted as prescribed. An intravenous infusion with a large-bore catheter is started, and oral food and fluid are restricted as time permits. Blood replacement is prepared only if the surgeon requests it. The patient is premedicated to reduce anxiety and discomfort. She should be placed in a slightly lateral (15°) position to reduce vena caval compression, supine hypotension, and resultant fetal hypoxia. General or regional anesthesia is initiated depending on the extent of fetal or maternal distress.

Postoperative: As soon as possible after delivery, the mother is allowed to see and touch her newborn. Once recovery is sufficient, the mother should have the opportunity to hold and or breast-feed her newborn. The pediatrician or nurse midwife or anesthetist assesses the newborn's status. The neonate is observed for signs of respiratory distress; resuscitative equipment is kept ready until the neonate is physiologically stable. Vital signs are monitored for mother and baby. The dressing and perineal pad are assessed for bleeding. The fundus is gently palpated for firmness (the incision is avoided), and intravenous oxytocin is administered as prescribed. If general anesthesia is used, routine postoperative care and positioning are provided; if regional anesthesia is used, the anesthesia level is assessed until sensation has completely returned. Intake and output are monitored, and evidence of blood-tinged urine is documented and reported. (The indwelling urinary catheter usually is removed within 48 hr.) For some mothers, a coldpack applied to the incision controls pain and swelling; if prescribed, analgesics are administered, and noninvasive pain-relief measures are instituted. Lochia and breasts are assessed. The mother is assisted to turn from side to side and is encouraged to breathe deeply, cough, and use incentive spirometry to improve ventilation and to mobilize secretions. When bowel sounds have returned, oral fluids and food are encouraged and bowel and bladder activity are monitored.

The mother is assisted with early ambulation to prevent pulmonary, vascular, and GI complications, and urged to visit her newborn in the nursery if the neonate is not healthy enough to be brought to her bedside. Usual postpartal instruction is provided regarding fundus, lochia, and perineal care; breast and nipple care; and infant care. Instruction is also given on incision care and the need to report any hemorrhage, chest or leg pain (possible thrombosis), dyspnea, separation of the wound's edges, or signs of infection, such as fever, difficult urination, or flank pain. Any restrictions on activity after discharge are discussed with the woman and her partner. Encourage the patient to share feelings about the experience, suggest participation in a cesarean birth sharing group if available and appropriate, and arrange for further psychological support as deemed necessary.
SYN: SEE: cesarean birth; SEE: C-section
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