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OPERATIA CEZARIANA TEHNICA,INDICATII, CONTRAINDICATII,
COMPLICATII .
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DEFINITIE
Operaţia cezariană este
intervenţia chirurgicală care constă
în extragerea fătului şi a anexelor sale din cavitatea uterină prin secţionarea peretelui
abdominal şi uterin.
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Considerente generale:
►OMS in 1995 a emis o afirmatie unanima declarand ca, depasirea ratei operatiei cezariene peste norma de 10-15% nu a fost urmata de imbunatatiri aditionale de sanatate ► In prezent in SUA o femeie din trei doreste operatia cezariana (28%).
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Indicatii Indicatii pentru cezariana in timpul sarcinii: ► - placenta praevia completa sau partiala: ► - abruptio placente moderata sau severa: ► - cicatrice anterioara clasica pe uter sau doua cicatrici ► - HTA de sarcina sau Sdr.HELLP; ► - candilom acumulat masiv in canalul de nastere; ► - patologie extravaginala decompensata; ► - suferinta fetala; ► - herpex simplex activ; E-le
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INDICATII
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INDICATII
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INDICATII Indicatii pentru operatia cezariana in timpul travaliului: ► -placenta praevia completa sau partiala: ► - abruptio placente moderata sau severa: ► - distocii in nastere; ► - bazin clinic stramtat; ► - malprezentari fetale; ► - suferinta fetala; ► - iminenta de ruptura uterina; ► - cordon ombilical prolabat;
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CONTRAINDICATII
DECES FETAL FAT NONVIABIL STAREA FATULUI INCOMPATIBILA CU VIATA
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CONDITII NECESARE
►Pregatirea profesionala corespunzatoare a
chirurgului; ►Prezenta echipamentului necesar si a sigurantei sanitare; ►Acordul pacientei;
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TEHNICA
► Standardul general acceptat in cazurile de suferinta fetala sau materna acuta
stipuleaza ca intervalul de timp intre
nastere si luarea deciziei nu trebuie sa
depaseasca 30 minute!
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TEHNICA
Metode de baza ale operatiei cezariene:
► - corporala; ► - intraperitoneala cu
anumite modificari
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TIPURI DE INCIZII
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TEHNICA Unele detalii ale tehnicii operatiei: ► -incizia uterina trebuie sa fie transversala la nivelul segmentul inferior; ► - extragerea placentei manual in cazul operatiei cezariene ar trebui evitata,mai ales la gravidele cu Rh negativ; ► - rezultatele inchiderii inciziei intr-un singur strat sau doua sunt similare, insa timpul castigat prin utilizarea intr-un singur strat este important;
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TEHNICA
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TEHNICA
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ANESTEZIA
►Anestezia generala; ►Blocul regional-
epidural,spinal. E-le
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CEZARIANA-ASPECT POSTOPERATOR
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COMPLICATII
► Operatia cezariana este considerata relativ sigura. ► Exista insa risc crescut in aparitia complicatiilor ► materne comparativ cu nasterea naturala. O ► pacienta cu operatie cezariana necesita un timp ► mai mare de recuperare fata de cea care a nascut ► natural. ► Complicatii serioase ce survin in primele 60 de ► zile dupa nastarea naturala si cezariana (la 1000 ► de femei)
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COMPLICATII Complicatii medicale ce necesita reinternare: 1.Dupa nasterea naturaCla 2.Dupa nasterea cezariana ► Toate complicatiile 10.0 17.0 ► Infectii uterine 2.9 5.2 ► Leziuni chirurgicale 0.1 3.9 E-le
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COMPLICATII ► Hemoragii, pierderi masive de sange ► 2.4 ► 2.9 ► Complicatii genitale sau urinare ► 1.3 ► 1.7 ► Complicatii pulmonare sau cardiace ► (cardioplumonare) ► 0.6 ► 1.3 ► Trombi sanguini (tromboembolism) ► 0.3 ► 0.9
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COMPLICATII TARDIVE ► Femeilor cu cicatrice uterina le creste
riscul aparitiei complicatiilor tardive. Aceste riscuri cresc cu
fiecare operatie cezariana adaugata si includ: - ruperea cicatricei uterine la o sarcina
ulterioara sau in timpul travaliului (ruperea uterina) - placenta praevia, adica implantarea
placentei in partea inferioara a uterului, blocand astfel
cervixul - placenta accreta, placenta increta si
placenta precreta (ultima fiind cea mai grava)
reprezentind dezvoltarea placentei in profunzimea
peretelui uterin, ceea ce poate duce la o hemoragie severa
dupa nastere, uneori necesitand histerectomie (indepartarea pe cale chirurgicala a
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INGRIJIRI POST-OPERATORII ► Dupa o operatie cezariana pacienta este monitorizata atent pentru urmatoarele 24 de ore in vederea preventiei complicatiilor. Pacienta va primi medicatie antialgica (contra durerii) si va fi incurajata sa se mobilizeze pe distante scurte inca din primele 24 de ore postoperator. Mersul poate ajuta la eliberarea gazelor acumulate in abdomen. De obicei mobilizarea este deranjanta, dar durerea se va reduce treptat la cateva zile dupa nastere. Perioada medie de spitalizare dupa cezariana este de 3 pana la 5 zile. Pacienta poate hrani si ingriji noul nascut imediat ce se simte in stare. Inainte de externare pacienta va primi instructiuni de ingrijire post-operatorie si date despre simptomele unor eventuale complicatii. Incizia abdominala se vindeca in medie in aproximativ 4 saptamini si este posibil ca pacienta sa prezinte dureri in zona respectiva pana la un an postoperator
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Va multumesc!
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