English task "caesarean Section"

ENGLISH TASK “Caesarean Section” Team : Ni Luh Enik Sumartini 16150027 Listi Eka Fitriana 16150014 Khevi Henoek 16150001 Nova Radja 16150003 PRODI D III KEBIDANAN UNIVERSITAS RESPATI YOGYAKARTA TAHUN AJARAN 2016/2017 Definition Caesarean section, also known as C-section, is the use of surgery to deliver one or more babies. A Caesarean section is often performed when a vaginal delivery would put the baby or mother at risk. This may includeobstructed labour, twin pregnancy, high blood pressure in the mother, breech birth, problems with the placenta,umbilical cord or shape of the pelvis, and previous C-section. A trial of vaginal birth in some of these situations, including after C-section, may be possible. Some C-sections are also performed upon request. The World Health Organization recommends that they should be done based on medical need and in many cases they are lifesaving for the mother and baby. A C-section typically takes 45 minutes to an hour. It may be done with a spinal block such that the woman is awake or under general anesthesia. A urinary catheter is used to drain the bladder and the skin of the abdomen is thensterilized. An incisions of about 15 cm (6 inches) is then typically made through the mother's lower abdomen. Theuterus is then opened with a second incision and the baby delivered. The incisions are then stitched closed. A woman can typically begin breastfeeding as soon as she is awake and out of the operating room. Often a number of days are required in hospital to recover sufficiently to return home. C-sections result in a small overall increase in poor outcomes in low risk pregnancies. They also typically take longer to heal from, about six weeks, than vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason. The method of delivery does not appear to have an effect on subsequent sexual function. In 2012, about 23 million C-sections were done globally. The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections. Some evidence finds a higher rate of 19% may result in better outcomes. More than 45 countries globally have C-section rates less than 7.5% while more than 50 have rates greater than 27%. There are efforts to both improve access to and reduce the use of C-section. In the United States about 33% of deliveries are by C-section. The surgery has been performed at least as far back as 715 BC following the death of the mother with the occasional baby surviving. Descriptions of mothers surviving date back to the 1500s. With the introduction of antiseptics and anesthetics in the 1800s survival of both the mother and baby became common Risks Adverse outcomes in low risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of caesarean section deliveries. Mother In those who are low risk, the risk of death for caesarean sections is 13 per 100,000 and for vaginal birth 3.5 per 100,000 in the developed world. The United Kingdom National Health Service gives the risk of death for the mother as three times that of a vaginal birth but it is important to remember the actual risk of death in either situation is extremely small in resource-rich settings. In Canada the difference in serious morbidity or mortality for the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100 or three times the risk. A caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction) and wound infections. If a caesarean is performed in an emergency, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the risk of anaesthesia. Other risks include severe blood loss (which may require a blood transfusion) and postdural-puncture spinal headaches. Women who had caesarean sections are more likely to have problems with later pregnancies, and it is recommended that women who want larger families should not seek an elective caesarean unless there are medical indications to do so. The risk of placenta accreta, a potentially life-threatening condition which is more likely to develop where a woman has had a previous caesarean section, is 0.13% after two caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. Mothers can experience increased incidence of postnatal depression, and can experience significant psychological trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process. Factors like pain in first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labour and delivery. Subsequent pregnancies Women who have had a caesarean for any reason are somewhat less likely to become pregnant again as compared to women who have previously delivered only vaginally, but the effect is small. Women who had just one previous caesarean section are more likely to have problems with their second birth. Delivery after previous Caesarean section is by either of two main options: birth after Caesarean section (VBAC) Elective repeat Caesarean section (ERCS) Both have higher risks than a vaginal birth with no previous caesarean section. There are many issues which must be taken into account when planning the mode of delivery for every pregnancy, not just those complicated by a previous caesarean section and there is a list of some of these issues in the list of indications for section in the first part of this article. A vaginal birth after caesarean section (VBAC) confers a higher risk of uterine rupture (5 per 1,000), blood transfusion orendometritis (10 per 1,000), and perinatal death of the child (0.25 per 1,000). Furthermore, 20% to 40% of planned VBAC attempts end in caesarean section being needed, with greater risks of complications in an emergency repeat caesarean section than in an elective repeat caesarean section. On the other hand, VBAC confers less maternal morbidity and a decreased risk of complications in future pregnancies than elective repeat caesarean section. There are number of steps that can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as the formation of adhesions. Such techniques and principles may include: Handling all tissue with absolute care Using powder-free surgical gloves Controlling bleeding Choosing sutures and implants carefully Keeping tissue moist Preventing infection with antibiotics given intravenously to the mother before skin incision However, despite these proactive measures, adhesion formation is a recognized complication of any abdominal or pelvic surgery. To prevent adhesions from forming after caesarean section, adhesion barrier can be put during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis. This is not current UK practice though as there is no compelling evidence to support the benefit of this intervention. Adhesions can cause long term problems, such as: Infertility, which may end when adhesions distort the tissues of the ovaries and tubes, impeding the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases may be adhesion related (stoval) Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50% of chronic pelvic pain cases are estimated to be adhesion related (stoval) Small bowel obstruction – the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. The risk of adhesion formation is one reason why vaginal delivery is usually considered safer than elective caesarean section where there is no medical indication for section for either maternal or fetal reasons. Child Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Complications from elective caesarean before 39 weeks include: newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks, and was elevated compared to 38 weeks gestation. These “early term” births were associated with more death during infancy, compared to those occurring at 39 to 41 weeks ("full term").Researchers in one study and another review found many benefits to going full term, but “no adverse effects” in the health of the mothers or babies. The American Congress of Obstetricians and Gynecologists and medical policy makers review research studies and find more incidence of suspected or provensepsis, RDS, hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In the case of caesarean sections, rates of respiratory death were 14 times higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2 times higher for pre-labor caesarean at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery before 39 weeks. For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery is recommended at between 37 and 38 weeks. Vaginal delivery in this case does not worsen the outcome for either infant as compared with caesarean section.There is some controversy on the best method of delivery where the first twin is head first and the second is not, but most obstetricians will recommend normal delivery unless there are other reasons to avoid vaginal birth. When the first twin is not head down, a caesarean section is often recommended. Regardless of whether the twins are delivered by section or vaginally, the medical literature recommends delivery of dichorionic twins at 38 weeks, and monochorionic twins (identical twins sharing a placenta) by 37 weeks due to the increased risk of stillbirth in monochorionic twins who remain in utero after 37 weeks. The consensus is that late preterm delivery of monochorionic twins is justified because the risk of stillbirth for post-37 week delivery is significantly higher than the risks posed by delivering monochorionic twins near term (i.e., 36–37 weeks). The consensus concerning monoamniotic twins (identical twins sharing an amniotic sac), the highest risk type of twins, is that they should be delivered by caesarean section at or shortly after 32 weeks, since the risks of intrauterine death of one or both twins is higher after this gestation than the risk of complications of prematurity. In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math. Other risks include: Wet lung: Retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor. Potential for early delivery and complications: Preterm delivery may be inadvertently carried out if due-date calculation is inaccurate. One study found an increased complication risk if a repeat elective caesarean section is performed even a few days before the recommended 39 weeks. Higher infant mortality risk: In caesarean sections performed with no indicated medical risk (singleton at full term in a head-down position with no other obstetric or medical complications), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had caesarean sections, compared to 0.62 per 1,000 for women who delivered vaginally. Birth by caesarean section also seems to be associated with worse health outcomes later in life, including overweight or obesitas and problems in the immune system https://en.wikipedia.org/wiki/Caesarean_section