Cesarean Birth Medical Quiz

Cesarean Birth

• Cesarean births are commonly performed as a prophylactic measure to address concerns like cephalopelvic disproportion, breech births, multiple fetuses, or failure to progress during labor.
• Incisions can be vertical (from belly button to pubic hairline) or horizontal (across pubic hairline); horizontal incisions generally heal better with less bleeding.
• Cesarean births are performed for abnormal fetal heart rates, abnormal fetal positions, labor problems, and large fetuses. Fetal heart rates are checked for rates between 120-160 bpm. If the heart rate doesn't improve, a C-section might be necessary.
• Maternal conditions like diabetes, high blood pressure, HIV, or active herpes sores might necessitate a cesarean.

Cesarean Birth Types

• Scheduled Cesarean: Procedures planned in advance, allowing ample time for preparation. Women require epidural anesthesia and face a higher risk of injury compared to vaginal births, potentially leading to preterm births.
• Emergent Cesarean: Procedures done urgently for conditions like placenta previa, premature placental separation, fetal distress, or failure to progress. Quick preparation is crucial; psychological and physical factors of the mother must be considered.

Effects of Cesarean Surgery on Women

• Physiological stress response, including epinephrine and norepinephrine release elevating heart rate, blood glucose, and blood pressure in response to surgical incision. This can increase risks of thrombophlebitis due to blood flow stasis.
• Interference with body defenses, impacting the skin's protective barrier and potentially increasing infection risk if the incision is done after membrane rupture. Prophylactic antibiotics are often administered.
• Interference with circulatory function, with higher blood loss (500-1000 ml) compared to a vaginal birth (300-500 ml) due to the handling of abdominal and pelvic vessels.
• Interference with self-image and self esteem as the incision can be noticeable, especially on those who desired a vaginal birth.

Preoperative Care Measures

• Obtain accurate medical history, including prior surgeries, allergies, or reactions to anesthesia.
• Assess the woman's level of understanding about the procedure and any special equipment involved.
• Document current medications, bleeding problems, and any past surgeries or diagnoses.

Operative Risk for a Woman

• Poor nutritional status of a woman can increase the risk of complications from surgery; tissue with higher fat content takes longer to heal. Increased risk of infections and incision rupture (dehiscence) are also possible.
• Insufficient protein, vitamin deficiencies (especially those of Vitamin C and D for new cell formation at the incision sites) can cause poorer healing post-surgery, as well as iron deficiency.
• Age variation as age affects surgical risk due to potentially decreased circulatory and renal function.
• Women older than 40 fall into a slightly higher category of risk compared to young adults.

Postpartum Hemorrhage

• One of the leading causes of maternal mortality post-childbirth. It typically refers to blood loss after birth, lasting 24 hours to 6 weeks postpartum.
• The four "T's" are recognized causes: uterine atony, trauma (lacerations or inversion), tissue retention (retained placenta), and thrombotic disorders.
• It is diagnosed from symptoms consistent with bleeding (excessive discharge, blood loss that saturates pads in a short span), and it can lead to further complications like anemia, infection, or possible organ failure.
• Conditions increasing a woman's risk of postpartum hemorrhage include pregnancy with multiples, polyhydramnios, large infants, placenta previa, rapid birth, anesthesia, high parity or older age, previous uterine surgeries, prolonged or difficult labor, and underlying health conditions like pre-existing anemia.

Postpartum Care

• Measures to regain energy after a cesarean birth such as: drink adequate fluids, rest for at least 30-60 minutes, delegate tasks to others, limit strenuous activities like walking upstairs.
• Managing home arrangements and any restrictions. Teaching women to recognize signs of issues like increased drainage, pain, and fever in the area of the incision, and lochia conditions.
• Providing contraceptive information, as fertility will not be impacted by the procedure.

Premature Infants

• A premature infant is born before 37 weeks of gestation, often needing intensive care due to underdeveloped organs.
• Risk factors include multiple pregnancies, bleeding issues, maternal infection, maternal stress/illnesses, genetic conditions, and age factors like the age of the mother.
• Symptoms in a premature infant can include a smaller body size, thinner skin, minimal body fat, little hair, weak cry, low muscle tone, and potentially small genitals.
• Premature infants might face complications like respiratory distress syndrome, anemia, bilirubin buildup, brain bleeds, and infections.
• Treatments focus on respiratory support (ventilators, surfactant), nutrition (IV fluids to support), temperature maintenance, and ongoing monitoring of the infant’s condition.

Gestational Age

• Small-for-gestational-age (SGA): Infants that have a birth weight below the 10th percentile for their gestational age, often due to intrauterine growth restriction during pregnancy or other causes.
• Large-for-gestational-age (LGA): Infants with a birth weight above the 90th percentile for their gestational age, often associated with maternal conditions like diabetes.

Meconium Aspiration Syndrome

• Meconium aspiration syndrome (MAS) happens when a baby inhales meconium (the first stool) during or immediately after birth. Possible causes are fetal distress, and prolonged labor.
• Symptoms vary depending on severity and include respiratory distress, bluish skin, breathing difficulties, and an x-ray that shows patches of opacity in the lungs.
• Treatment usually involves oxygen and supportive care; respiratory support, medications, or ECMO may be needed in severe cases.

Neonatal Sepsis

• Neonatal sepsis, which is an invasive bacterial infection in newborns that often occurs during the first few days after birth, may cause permanent damage to an infant's brain.
• Factors raising a baby's risk for neonatal sepsis are pre-term birth, prolonged rupture of membranes that could expose the fetus to infection, and bacterial colonization in the mother.
• Symptoms include decreased activity, less vigorous sucking, apnea, low heart rate, and unstable temperature, along with other indicators like vomiting, diarrhea, respiratory distress, jitteriness, or jaundice.

Hyperbilirubinemia

• Hyperbilirubinemia occurs when there's a buildup of bilirubin in an infant's bloodstream. Often presenting as noticeable jaundice (yellow skin and eyes).
• Blood type incompatibility between mother and fetus cause hemolysis (red blood cell destruction) due to Rh or ABO incompatibility factors, resulting in premature newborns being more prone to hyperbilirubinemia.
• Symptoms usually involve jaundice but can be severe and cause further complications, impacting the infant's overall well-being. Therapies include phototherapy, exchange transfusions, and supportive care like appropriate nutrition and feeding strategies.

Sudden Infant Death Syndrome (SIDS)

• The sudden, unexpected death of an infant under 1 year that has no explanation.
• Risk factors include prone sleep position, overheating, smoking exposure, soft bedding, or a family history of SIDS.

Test your knowledge about cesarean births with this insightful quiz. Explore topics such as blood loss, self-consciousness, and uterine handling. Understand the importance of assessing additional organs post-surgery.