A CaseStudy of CesareanDelivery (BreechPresentation)

PATIENTS PROFILE Name:MADIZ ARLENE Age:28 years old Gender:Female Civil Status:Married Nationality:Filipino Address: Carmona Cavite Religion:Roman Catholic Date of Birth:August 02, 1981 Date of Admission: SEPTEMBER 23,2012 Final Diagnosis:PUFT Cephalic in Labor with alive Baby BoyG2P2 (2002) Previous CS on BreechPresentation Patients History: chief complain: For CSHistory: Patient came schedule for CS. Nohypogastric pain, Vaginal bleeding, ruptured BOW,vomiting Physical Examination: -Conscious and coherent -Warm , good skin turgor -Anecentric sclera, pink ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

EXTERNAL GENITALIA Our overview of the reproductive system begins at the external genitalarea or vulvawhich runs from the pubic area downward to the rectum. Twofolds of fatty, fleshy tissue surround the entrance to the vagina and the urinaryopening: the labia majora, or outer folds, and the labia minora, or inner folds, located under the labia majora. The clitoris, is a relatively short organ (less thanone inch long), shielded by a hood of flesh. When stimulated sexually,

the clitoriscan become erect like a man's penis. The hymen, a thin membrane protectingthe entrance of the vagina, stretches when you insert a tampon or haveintercourse.

INTERNAL REPRODUCTIVE STRUCTURE The Vagina The vagina is a muscular, ridged sheath connecting the externalgenitals to the uterus, where the embryo grows into a fetus during pregnancy.In the reproductive process, the vagina functions as a two-way street,accepting the penis and sperm during intercourse and roughly nine monthslater, serving as the avenue of birth through which the new baby enters theworld . The Cervix The vagina ends at the cervix, the lower portion or neck of the uterus.Like the vagina, the cervix has dual reproductive functions. After intercourse, sperm ejaculated in the vagina pass through thecervix, then proceed through the uterus to the fallopian tubes where, if asperm encounters an ovum (egg), conception occurs. The cervix is lined withmucus, the quality and quantity of which is governed by monthly fluctuationsin the levels of the two principle sex hormones, estrogen and progesterone.When estrogen levels are low, the mucus tends to be thick and sparse,which makes it difficult for sperm to reach the fallopian tubes. But when anegg is ready for fertilization and estrogen levels are high the mucus thenbecomes thin and slippery, offering a much more friendly environment tosperm as they struggle towards their goal. (This phenomenon is employed bybirth control pills, shots and implants. One of the ways they preventconception is to render the cervical mucus thick, sparse, and hostile tosperm.) Uterus The uterus or womb is the major female reproductiveorganof humans.One end, thecervix, opens into thevagina; the other is connected on bothsides to thefallopian tubes. The uterus mostly consists of muscle, known as myometrium. Its majorfunction is to accept a fertilizedovumwhich becomes implanted into theendometrium, and derives nourishment from blood vessels which develop exclusivelyfor this purpose. The fertilized ovum becomes anembryo, develops into afetusandgestates untilchildbirth.

Oviducts The Fallopian tubes or oviducts are two very fine tubes leading from theovariesof femalemammalsinto theuterus.On maturity of an ovum, the follicle and the ovary's wall rupture,allowing the ovum to escape and enter the Fallopian tube. There it travelstoward the uterus, pushed along by movements of ciliaon the inner lining of the tubes. This trip takes hours or days. If the ovum isfertilizedwhile in theFallopian tube, then it normally implants in theendometriumwhen it reachesthe uterus, which signals the beginning of pregnancy. Ovaries The ovaries are the place inside the female body whereovaoreggsareproduced. The process by which the ovum is released is calledovulation. Thespeed of ovulation isperiodicand impacts directly to the length of amenstrual cycle.After ovulation, the ovum is captured by theoviduct, where it travelleddown the oviduct to the uterus, occasionally beingfertilisedon its way by an incomingsperm, leading topregnancyand the eventual birth of a new humanbeing. The Fallopian tubes are often called the oviducts and they have smallhairs (cilia) to help the egg cell travel. INDICATIONS FOR THE PROCEDURE CAESARIAN SECTION

A Caesarian section is a form of childbirth in which a surgical incision ismade through a mothers abdomen and uterus to deliver one or more babies.It is usually performed when a vaginal delivery would put the babys ormothers life or health at risk; although in recent times it has been alsoperformed upon requests for births that would otherwise have been normal.

Caesarian section (CS) is recommended when vaginal delivery mightpose a risk to the mother or baby. Reasons for CS include: Precious (high risk) fetus Prolonged labor or failureto progress (dystocia Apparent fetal distress Apparent maternal distress Complications (pre-eclampsia, active herpes)

Catastrophes such as cord prolapse or uterine rupture Multiple births Abnormal presentation (breech or transverse positions) Failed induction of labor Failed instrumental delivery The baby is too large (macrosomia) Placental problems (placenta previa, placental abruption/ placenta accrete) Umbilical cord abnormalities Contracted pelvis Sexually transmitted infections such as genital herpes Previous caesarian section Old age Breech Presentation

Breech Presentation Most fetuses are in breech position early in pregnancy. However,by week 38 fetus normally turns to a cephalic presentation. Although the fetal head is widest single diameter, the fetussbuttocks (Breech), plus the legs, actually take up more space. Thefact that the fundus is the largest part of the uterus is probably thereason why in approximately 97% of all pregnancies, the fetusturns so that the buttock and lower extremities are in the fundus. There are several types of breech presentation: complete, frankand footling. Breech presentation is more hazardous to a fetusthan a cephalic presentation, because there is a higher risk of thefollowing complications: -Anoxia from the prolapsed cord -Traumatic injury to the after coming head -Fracture of the spine of arm-Dysfunctional labor -Early rupture of the membrane because of the poor fit of thepresenting part. The inevitable contraction of the fetal buttocks from cervicalpressure often causes meconium to be extruded into the amnioticfluid before birth. This, unlike meconium staining that occurs dueto fetal anoxia, is not a sign of fetal distress but expected from thebuttock pressure. Such meconium excretion can however, lead tomeconium aspiration if the infant inhales amniotic fluid.