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Caesarean Birth
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Cesarean delivery is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy).

Cesarean deliveries were initially performed to separate the mother and the fetus in an attempt to save the fetus of a moribund patient. They subsequently developed to resolve maternal or fetal complications not amenable to vaginal delivery, either for mechanical limitations or to temporize delivery for maternal or fetal benefit.
 

The leading indications for cesarean delivery (85%) are previous cesarean delivery, breech presentation, dystocia, and fetal distress.
 

Maternal indications for cesarean delivery include the following:
 

1. Repeat cesarean delivery
 

2. Obstructive lesions in the lower genital tract, including malignancies, large vulvovaginal condylomas, obstructive vaginal septa, and leiomyomas of the lower uterine segment that interfere with engagement of the fetal head
 

3. Pelvic abnormalities that preclude engagement or interfere with descent of the fetal presentation in labor
 

Fetal indications for cesarean delivery include the following:
 

1. Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma
 

2. Malpresentations (eg, preterm breech presentations, non-frank breech term fetuses)
 

3. Certain congenital malformations or skeletal disorders
 

4. Infection
 

5. Prolonged acidemia
 

Indications for cesarean delivery that benefit the mother and the fetus include the following:
 

Abnormal placentation (eg, placenta previa, placenta accreta)
 

Abnormal labor due to cephalopelvic disproportion
 

Situations in which labor is contraindicated
 

Evaluation by the surgeon and the anesthesiologist
 

Laboratory testing
 

The following laboratory studies may be obtained prior to cesarean delivery:
 

Complete blood count
 

Blood type and screen, cross-match
 

Screening tests for human immunodeficiency virus, hepatitis B, syphilis
 

Coagulation studies (eg, prothrombin and activated partial thromboplastin times, fibrinogen level)

Imaging studies
 

In labor and delivery, document fetal position and estimated fetal weight. Although ultrasonography is commonly used to estimate fetal weight, a prospective study reported the sensitivity of clinical and ultrasonographic prediction of macrosomia, respectively, as 68% and 58%.
 

Complications
 

Approximately 2-fold increase in maternal mortality and morbidity with cesarean delivery relative to a vaginal delivery : Partly related to the procedure itself, and partly related to conditions that may have led to needing to perform a cesarean delivery
 

Infection (eg, postpartum endomyometritis, fascial dehiscence, wound, urinary tract)
 

Thromboembolic disease (eg, deep venous thrombosis, septic pelvic thrombophlebitis)
 

Anesthetic complications
 

Surgical injury (eg, uterine lacerations; bladder, bowel, ureteral injuries)
 

Uterine atony
 

Delayed return of bowel function

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