187-454: Caesarean section , also known as C-section , cesarean, or caesarean delivery , is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk. Reasons for the operation include obstructed labor , twin pregnancy , high blood pressure in the mother, breech birth , shoulder presentation , and problems with
374-415: A Pfannenstiel incision but there is no way of knowing from the skin scar which way the uterine incision was conducted. The EXIT procedure is a specialized surgical delivery procedure used to deliver babies who have airway compression. The Misgav Ladach method is a modified caesarean section which has been used nearly all over the world since the 1990s. It was described by Michael Stark, the president of
561-474: A radiosurgical procedure (e.g. irradiation of a tumor). Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation. Inpatient surgery is performed in a hospital, and the person undergoing surgery stays at least one night in the hospital after the surgery. Outpatient surgery occurs in a hospital outpatient department or freestanding ambulatory surgery center, and
748-525: A surgical procedure or surgical operation , or simply "surgery" or "operation". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments , surgical facility or surgical nurse . Most surgical procedures are performed by a pair of operators: a surgeon who is the main operator performing the surgery, and a surgical assistant who provides in-procedure manual assistance during surgery. Modern surgical operations typically require
935-412: A surgical team that typically consists of the surgeon, the surgical assistant, an anaesthetist (often also complemented by an anaesthetic nurse ), a scrub nurse (who handles sterile equipment), a circulating nurse and a surgical technologist , while procedures that mandate cardiopulmonary bypass will also have a perfusionist . All surgical procedures are considered invasive and often require
1122-486: A $ 12.3 trillion loss in economic productivity by the year 2030. This was especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide. It emphasized the need to significantly improve the capacity for Bellwether procedures – laparotomy , caesarean section , open fracture care – which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture
1309-408: A 2021 systematic review of the evidence on outpatient cervical ripening found that in women with low-risk pregnancies, the risk of cesarean delivery with harms to the mother or child were not significantly different from when done in an inpatient setting. Adverse outcomes in low-risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of caesarean section deliveries. In those who are low risk,
1496-500: A Component of Universal Health Coverage . The Lancet Commission for Global Surgery outlined the need for access to "available, affordable, timely and safe" surgical and anesthesia care; dimensions paralleled in ICESCR General Comment No. 14, which similarly outlines need for available, accessible, affordable and timely healthcare. Surgical treatments date back to the prehistoric era. The oldest for which there
1683-484: A blood transfusion) and post-dural-puncture spinal- headaches . Wound infections occur after caesarean sections at a rate of 3–15%. The presence of chorioamnionitis and obesity predisposes the woman to develop a surgical site infection. Women who had caesarean sections are more likely to have problems with later pregnancies, and women who want larger families should not seek an elective caesarean unless medical indications to do so exist. The risk of placenta accreta ,
1870-426: A cesarean section is the safest delivery method. The WHO recommends a C-section rate of between 10 and 15% because C-sections rates higher than 10% are not associated with a decrease in morbidity and mortality. In 2018, a group of medical professionals called the rates of increase around the world "alarming". In a Lancet report, C-sections were found to have more than tripled from about 6% of all births to 21%. In
2057-614: A component of universal health coverage." This not only mandated the WHO to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. Additionally, the third edition of Disease Control Priorities (DCP3), published in 2015 by the World Bank , declared surgery as essential and featured an entire volume dedicated to building surgical capacity. Data from WHO and
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#17327661992832244-452: A delivery team which includes a support person who will advocate to assure that: It has long been known that a mother's level of the hormone oxytocin elevates in a mother when she interacts with her infant. In 2019, a large review of the effects of oxytocin found that the oxytocin level in fathers that engage in SSC is increased as well. Two studies found that "when the infant is clothed only in
2431-483: A diaper and placed in between the mother or father's breasts, chest-to-chest [elevated paternal oxytocin levels were] shown to reduce stress and anxiety in parents after interaction." For births that occur in hospitals the WHO recommends a hospital stay of at least 24 hours following an uncomplicated vaginal delivery and 96 hours for a Cesarean section. Looking at length of stay (in 2016) for an uncomplicated delivery around
2618-401: A fluid-filled sac. Usually the sac ruptures at the beginning of or during labour. It may cause a gush of fluid or leak in an intermittent or constant flow of small amounts from a woman's vagina. The fluid is clear or pale yellow. If the amniotic sac has not yet broken during labour the health care provider may break it in a technique called an amniotomy . In an amniotomy a thin plastic hook
2805-473: 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%. Efforts are being made to both improve access to and reduce the use of C-section. In the United States as of 2017, about 32% of deliveries are by C-section. The surgery has been performed at least as far back as 715 BC following the death of
2992-419: A justification for C-section; a new definition of the start of active labor from a cervical dilatation of 4 cm to a dilatation of 6 cm; and allowing women who have previously given birth to push for at least 2 hours, with 3 hours of pushing for women who have not previously given birth, before labor arrest is considered. Physical exercise during pregnancy decreases the risk. Additionally, results from
3179-696: A less irritating emollient, made of egg yolk , rose oil and turpentine . He also described more efficient techniques for the effective ligation of the blood vessels during an amputation . Childbirth#First stage Childbirth , also known as labour , parturition and delivery , is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section . In 2019, there were about 140.11 million human births globally. In developed countries , most deliveries occur in hospitals , while in developing countries most are home births . The most common childbirth method worldwide
3366-455: A medication to delay delivery. There is currently no definitive scientific explanation for why labour is painful. According to studies, during pregnancy, the myometrium (the muscle part of the uterus) is greatly denervated. Stretch receptors in the uterus disappear during pregnancy, and stretch receptors in the cervix disappear at the onset of labour. Consequently, the reason for labour pain has only been theorised, not ascertained. One theory
3553-537: A method of delivery. In cases without medical indications the American Congress of Obstetricians and Gynecologists and the UK Royal College of Obstetricians and Gynaecologists recommend a planned vaginal delivery. The National Institute for Health and Care Excellence recommends that if after a woman has been provided information on the risk of a planned caesarean section and she still insists on
3740-530: A military physician". The researchers were impressed by the complexity of the brain surgical operation. In 1991 at the Polystylon fort in Greece, researchers discovered the head of a Byzantine warrior of the 14th century. Analysis of the lower jaw revealed that a surgery has been performed, when the warrior was alive, to the jaw which had been badly fractured and it tied back together until it healed. During
3927-513: A period of postoperative care (sometimes intensive care ) for the patient to recover from the iatrogenic trauma inflicted by the procedure. The duration of surgery can span from several minutes to tens of hours depending on the specialty , the nature of the condition, the target body parts involved and the circumstance of each procedure, but most surgeries are designed to be one-off interventions that are typically not intended as an ongoing or repeated type of treatment. In British colloquialism,
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#17327661992834114-498: A peripheral IV line is placed, and pre-operative medications (antibiotics, sedatives, etc.) are given. When the patient enters the operating room and is appropriately anesthetized, the team will then position the patient in an appropriate surgical position . If hair is present at the surgical site, it is clipped (instead of shaving). The skin surface within the operating field is cleansed and prepared by applying an antiseptic (typically chlorhexidine gluconate in alcohol, as this
4301-414: A person shows signs of infection and not as a preventative. A systematic review published by Cochrane (organisation) in 2016, though, concluded that topical antibiotics applied over certain types of surgical wounds reduce the risk of surgical site infections, when compared to no treatment or use of antiseptics . The review also did not find conclusive evidence to suggest that topical antibiotics increased
4488-403: A physical exam which did not indicate a chest x-ray. Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the person. Likewise, other tests including complete blood count , prothrombin time , partial thromboplastin time , basic metabolic panel , and urinalysis should not be done unless
4675-544: 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 an increased incidence of postnatal depression , and can experience significant psychological trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during
4862-550: A prehistoric individual from the Indus River valley show evidence of teeth having been drilled. Sushruta Samhita is one of the oldest known surgical texts and its period is usually placed in the first millennium BCE. It describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures for various forms of cosmetic surgery, plastic surgery and rhinoplasty . In 1982 archaeologists were able to find significant evidence when
5049-440: A recent study done with lumbar decompressions, the patient's length of stay was decreased by 1–3 days. The use of topical antibiotics on surgical wounds to reduce infection rates has been questioned. Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developing contact dermatitis and antibiotic resistance . It has also been suggested that topical antibiotics should only be used when
5236-451: A result of reduced numbers of actual vaginal breech deliveries, obstetricians and midwives are at risk of de-skilling in this important skill. All those involved in delivery of obstetric and midwifery care in the UK undergo mandatory training in conducting breech deliveries in the simulation environment (using dummy pelvises and mannequins to allow practice of this important skill) and this training
5423-466: A risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications. If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way. It is not uncommon for surgical drains to be required to remove blood or fluid from
5610-530: A scheduled cesarean section must be planned for a successful delivery and recovery of the mother. An emergency cesarean section may be recommended if unexpected complications occur or little to no progression through the birthing canal is observed in a vaginal delivery. Each year, complications from pregnancy and childbirth result in about 500,000 birthing deaths , seven million women have serious long-term problems, and 50 million women giving birth have negative health outcomes following delivery, most of which occur in
5797-480: A scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure. Prior to surgery, the person is given a medical examination , receives certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system . If these results are satisfactory,
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5984-648: A specialty of medicine, rather than an accessory field. Basic surgical principles for asepsis etc., are known as Halsteads principles . There were some important advances to the art of surgery during this period. The professor of anatomy at the University of Padua , Andreas Vesalius , was a pivotal figure in the Renaissance transition from classical medicine and anatomy based on the works of Galen , to an empirical approach of 'hands-on' dissection. In his anatomic treaties De humani corporis fabrica , he exposed
6171-529: A statement by the maternal and child health organisation, the March of Dimes , the increase is largely due to an increase of elective C-sections rather than when it is really necessary or indicated. Looking at the C-section rates between 1976 and 1996, one large study done in the U.S. found that the proportion of pregnancies delivered by C section increased from 6.7% in 1976 to 14.2% in 1996, with maternal choice
6358-470: A weekend, and also, decrease number and level of experience over a weekend. Postoperative pain affects an estimated 80% of people who underwent surgery. While pain is expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines. There
6545-435: Is a medical reason. Planned caesarean sections may be scheduled earlier if there is a medical reason. Mothers who have previously had a caesarean section are more likely to have a caesarean section for future pregnancies than mothers who have never had a caesarean section. There is discussion about the circumstances under which women should have a vaginal birth after a previous caesarean. Vaginal birth after caesarean (VBAC)
6732-499: Is a recognized complication of any abdominal or pelvic surgery. To prevent adhesions from forming after caesarean section, adhesion barrier can be placed 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, as there is no compelling evidence to support the benefit of this intervention. Adhesions can cause long-term problems, such as: The risk of adhesion formation
6919-434: Is a secondary priority only, and the procedure may be performed even prior to the limit of fetal viability if it is judged to be of benefit to the mother. There are several types of caesarean section (CS). An important distinction lies in the type of incision (longitudinal or transverse) made on the uterus , apart from the incision on the skin: the vast majority of skin incisions are a transverse suprapubic approach known as
7106-501: Is a technique of newborn care where babies are kept chest-to-chest and skin-to-skin with a parent, typically their mother or possibly the father. This means without the shirt or undergarments on the chest of both the baby and parent. A 2011 medical review found that early skin-to-skin contact resulted in a decrease in infant crying, improved cardio-respiratory stability and blood glucose levels, and improved breastfeeding duration. A 2016 Cochrane review also found that SSC at birth promotes
7293-558: Is about to begin may include what is known as lightening , which is the process of the baby moving down from the rib cage with the head of the baby engaging deep in the pelvis. The pregnant woman may then find breathing easier, since her lungs have more room for expansion, but pressure on her bladder may cause more frequent need to void (urinate). Lightening may occur a few weeks or a few hours before labour begins, or even not until labour has begun. Some women also experience an increase in vaginal discharge several days before labour begins when
7480-443: Is achieved through labour induction or caesarean section , also called a C-section. Labour induction is the process or treatment that stimulates childbirth and delivery. Inducing labour can be accomplished with pharmaceutical or non-pharmaceutical methods. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment. Caesarean section
7667-417: Is administered to prevent pain from the trauma of cutting, tissue manipulation, application of thermal energy, and suturing. Depending on the type of operation, anesthesia may be provided locally, regionally , or as general anesthesia . Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia,
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7854-413: Is advised that the newborn be placed skin-to-skin with the mother following vaginal birth, or as soon as the mother is alert and responsive after a Caesarean section, postponing any routine procedures for at least one to two hours. The baby's father or other support person may also choose to hold the baby SSC until the mother recovers from the anaesthetic. The WHO suggests that any initial observations of
8041-488: Is also considered for logistical reasons, such as the distance from hospital or psychosocial conditions, but in these instances gestational age confirmation must be done, and the maturity of the fetal lung must be confirmed by testing. The ACOG also note that contraindications for induced labour are the same as for spontaneous vaginal delivery, including vasa previa , complete placenta praevia , umbilical cord prolapse or active genital herpes simplex infection, in which cases
8228-647: Is among the controversial topics related to surgery in children. Doctors perform surgery with the consent of the person undergoing surgery. Some people are able to give better informed consent than others. Populations such as incarcerated persons , people living with dementia , the mentally incompetent, persons subject to coercion, and other people who are not able to make decisions with the same authority as others, have special needs when making decisions about their personal healthcare, including surgery. Global surgery has been defined as 'the multidisciplinary enterprise of providing improved and equitable surgical care to
8415-426: Is an empty stomach or that its contents are not as acidic. They therefore conclude that "women should be free to eat and drink in labour, or not, as they wish." At one time shaving of the area around the vagina , was common practice due to the belief that hair removal reduced the risk of infection, made an episiotomy (a surgical cut to enlarge the vaginal entrance) easier, and helped with instrumental deliveries. It
8602-449: Is applied to the area of the person's body that will be operated on. Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Work to correct the problem in body then proceeds. This work may involve: Blood or blood expanders may be administered to compensate for blood lost during surgery. Once
8789-444: Is being done to find a solution.As such, surgical care globally has been described as the 'neglected stepchild of global health,' a term coined by Paul Farmer to highlight the urgent need for further work in this area. Furthermore, Jim Young Kim , the former President of the World Bank , proclaimed in 2014 that "surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage." In 2015,
8976-399: Is bottom-down instead of head-down. Babies born bottom-first are more likely to be harmed during a normal (vaginal) birth than those born head-first. For instance, the baby might not get enough oxygen during the birth. Having a planned caesarean may reduce these problems. A review looking at planned caesarean section for singleton breech presentation with planned vaginal birth, concludes that in
9163-539: Is by either of two main options: Both have higher risks than a vaginal birth with no previous caesarean section. A vaginal birth after caesarean section (VBAC) confers a higher risk of uterine rupture (5 per 1,000), blood transfusion or endometritis (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
9350-407: Is carried out regularly to keep skills up to date. A resuscitative hysterotomy , also known as a peri-mortem caesarean delivery, is an emergency caesarean delivery carried out where maternal cardiac arrest has occurred, to assist in resuscitation of the mother by removing the aortocaval compression generated by the gravid uterus. Unlike other forms of caesarean section, the welfare of the fetus
9537-408: Is comparable to the overall vaginal delivery rate in the United States in 2010. 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 controversy on the best method of delivery where the first twin
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#17327661992839724-481: Is credited with the performance of the first thyroidectomy . Al-Zahrawi pioneered techniques of neurosurgery and neurological diagnosis, treating head injuries , skull fractures , spinal injuries , hydrocephalus , subdural effusions and headache . The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi, who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children. In Europe ,
9911-436: Is currently less common, though it is still a routine procedure in some countries even though a systematic review found no evidence to recommend shaving. Side effects appear later, including irritation, redness, and multiple superficial scratches from the razor. Another effort to prevent infection has been the use of the antiseptic chlorhexidine or providone-iodine solution in the vagina. Evidence of benefit with chlorhexidine
10098-465: Is difficult labour or abnormally slow progress of labour, involving progressive cervical dilatation or lack of descent of the fetus. Friedman's Curve, developed in 1955, was for many years used to determine labour dystocia. However, more recent medical research suggests that the Friedman curve may not be currently applicable. The expulsion stage begins when the cervix is fully dilated, and ends when
10285-610: Is 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 proven sepsis , RDS, hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In
10472-751: Is evidence is trepanation , in which a hole is drilled or scraped into the skull , thus exposing the dura mater in order to treat health problems related to intracranial pressure. Prehistoric surgical techniques are seen in Ancient Egypt , where a mandible dated to approximately 2650 BC shows two perforations just below the root of the first molar , indicating the draining of an abscessed tooth . Surgical texts from ancient Egypt date back about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today, and used sutures to close wounds. Infections were treated with honey. 9,000-year-old skeletal remains of
10659-433: Is expelled until just after the placenta is expelled is called the third stage of labour or the involution stage . Placental expulsion begins as a physiological separation from the wall of the uterus. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10–12 minutes dependent on whether active or expectant management is employed. In as many as 3% of all vaginal deliveries,
10846-417: Is generally agreed to be higher than needed in many countries, and physicians are encouraged to actively lower the rate, as a caesarean rate higher than 10–15% is not associated with reductions in maternal or infant mortality rates, although some evidence support that a higher rate of 19% may result in better outcomes. Some of these efforts are: emphasizing a long latent phase of labor is not abnormal and not
11033-482: Is generally recommended as a first option. Cesarean section can lead to increased risk of complications and a significantly slower recovery. There are also many natural benefits of a vaginal delivery in both mother and baby. Various methods may help with pain, such as relaxation techniques , opioids , and spinal blocks . It is best practice to limit the amount of interventions that occur during labour and delivery such as an elective cesarean section, however in some cases
11220-408: Is head first and the second is not. When the first twin is not head down at the point of labor starting, a caesarean section should be recommended. Although the second twin typically has a higher frequency of problems, it is not known if a planned caesarean section affects this. It is estimated that 75% of twin pregnancies in the United States were delivered by caesarean section in 2008. A breech birth
11407-411: 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: Birth by caesarean section also seems to be associated with worse health outcomes later in life, including overweight or obesity, problems in
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#173276619928311594-561: Is increasingly recognized as an integral aspect of healthcare and therefore is evolving into a normative derivation of human right to health . The ICESCR Article 12.1 and 12.2 define the human right to health as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" In the August 2000, the UN Committee on Economic, Social and Cultural Rights (CESCR) interpreted this to mean "right to
11781-500: Is insufficient evidence to determine if giving opioid pain medication pre-emptively (before surgery) reduces postoperative pain the amount of medication needed after surgery. Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities. Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge. In 2011, of
11968-441: 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
12155-453: Is known to evoke feelings of contentment, reductions in anxiety, and feelings of calmness and security around the mate. Oxytocin is further released during labour when the fetus stimulates the cervix and vagina, and it is believed that it plays a major role in the bonding of a mother to her infant and in the establishment of maternal behaviour. Studies show that the father of the child also has an increase in oxytocin levels following contact with
12342-561: Is lacking. A decreased risk is found with providone-iodine when a cesarean section is to be performed. An assisted delivery is used in about 1 in 8 births, and may be needed if either mother or infant appears to be at risk during a vaginal delivery. The methods used are termed obstetrical forceps extraction and vacuum extraction , also called ventouse extraction. Done properly, they are both safe with some preference for forceps rather than vacuum, and both are seen as preferable to an unexpected C-section. While considered safe, some risks for
12529-456: Is made to access the surgical site. Blood vessels may be clamped or cauterized to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then the peritoneum. In certain cases, bone may be cut to further access
12716-787: Is needed, with some studies indicating peritoneal closure is associated with longer operative time and hospital stay. The Misgav Ladach method is a surgery technical that may have fewer secondary complications and faster healing, due to the insertion into the muscle. Surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery such as gastric bypass ), to reconstruct or improve aesthetics and appearance ( cosmetic surgery ), or to remove unwanted tissues ( body fat , glands , scars or skin tags ) or foreign bodies . The act of performing surgery may be called
12903-543: Is not a medical indication to have the surgery. Systematic reviews have found no strong evidence about the impact of caesareans for nonmedical reasons. Recommendations encourage counseling to identify the reasons for the request, addressing anxieties and information, and encouraging vaginal birth. Elective caesareans at 38 weeks in some studies showed increased health complications in the newborn. For this reason ACOG and NICE recommend that elective caesarean sections should not be scheduled before 39 weeks gestation unless there
13090-448: 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
13277-410: 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. Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks, and
13464-420: Is out of the operating room and awake. Often, several days are required in the 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 about six weeks to heal from, longer than vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in
13651-400: 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
13838-436: Is referred to as "delivery en caul ". Complete expulsion of the baby signals the successful completion of the second stage of labour. Some babies, especially preterm infants, are born covered with a waxy or cheese-like white substance called vernix . It is thought to have some protective roles during fetal development and for a few hours after birth. The second stage varies from one woman to another. In first labours, birth
14025-424: Is safer for one or both, and the classification of urgency of the delivery is an important issue affecting this decision. A planned caesarean (or elective/scheduled caesarean), arranged ahead of time, is most commonly arranged for medical indications which have developed before or during the pregnancy, and ideally after 39 weeks of gestation. In the UK, this is classified as a 'grade 4' section (delivery timed to suit
14212-428: Is some other indication, mothers can attempt a trial of labour and most are able to have a vaginal birth after C-section (VBAC). Induced births and elective cesarean before 39 weeks can be harmful to the neonate as well as harmful or without benefit to the mother. Therefore, many guidelines recommend against non-medically required induced births and elective cesarean before 39 weeks. The 2012 rate of labour induction in
14399-407: Is that the pain results from the buildup of chemicals released during physical exertion. The second leading theory is that the pain results from the vasoconstriction of uterine blood vessels in the myometrium; each contraction squeezes the blood vessels, reducing blood flow and causing some hypoxia . During the later stages of gestation, there is an increase in abundance of oxytocin , a hormone that
14586-401: Is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly. However, medical specialty professional organizations recommend against routine pre-operative chest x-rays for people who have an unremarkable medical history and presented with
14773-401: Is the birth of a baby from a breech presentation , in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation . In breech presentation, fetal heart sounds are heard just above the umbilicus. Babies are usually born head first. If the baby is in another position the birth may be complicated. In a 'breech presentation', the unborn baby
14960-697: Is the practice of birthing a baby vaginally after a previous baby has been delivered by caesarean section (surgically). According to the American College of Obstetricians and Gynecologists (ACOG), successful VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. According to the American Pregnancy Association, 90% of women who have undergone caesarean deliveries are candidates for VBAC. Approximately 60–80% of women opting for VBAC will successfully give birth vaginally, which
15147-519: Is the removal of the neonate through a surgical incision in the abdomen, rather than through vaginal birth. During the procedure the patient is usually numbed with an epidural or a spinal block, but general anaesthesia can be used as well. A cut is made in the patient's abdomen and then in the uterus to remove the baby. Before the 1970s, once a patient delivered one baby via C-section, it was recommended that all of her future babies be delivered by C-section, but that recommendation has changed. Unless there
15334-415: Is to group them by their focus either on the urgency of the procedure (most common), characteristics of the mother, or as a group based on other, less commonly discussed factors. Conventionally, caesarean sections are classified as being either an elective surgery or an emergency operation. Classification is used to help communication between the obstetric, midwifery and anaesthetic team for discussion of
15521-424: Is twice as effective as povidone-iodine at reducing the risk of infection). Sterile drapes are then used to cover the borders of the operating field . Depending on the type of procedure, the cephalad drapes are secured to a pair of poles near the head of the bed to form an "ether screen", which separate the anesthetist / anesthesiologist 's working area (unsterile) from the surgical site (sterile). Anesthesia
15708-416: Is used to make a small opening in the sac, causing the water to break. If the sac breaks before labour starts, it's called a prelabour rupture of membranes . Contractions will typically start within 24 hours after the water breaks. If not, the care provider will generally begin labour induction within 24 to 48 hours. If the baby is preterm (less than 37 weeks of pregnancy), the healthcare provider may use
15895-404: Is usually completed within three hours whereas in subsequent labours, birth is usually completed within two hours. Second-stage labours longer than three hours are associated with declining rates of spontaneous vaginal delivery and increasing rates of infection, perineal tears , and obstetric haemorrhage, as well as the need for intensive care of the neonate. The period from just after the fetus
16082-410: Is vaginal delivery. It involves four stages of labour : the shortening and opening of the cervix during the first stage, descent and birth of the baby during the second, the delivery of the placenta during the third, and the recovery of the mother and infant during the fourth stage, which is referred to as the postpartum . The first stage is characterised by abdominal cramping or also back pain in
16269-524: The Islamic Golden Age , largely based upon Paul of Aegina 's Pragmateia , the writings of Albucasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practiced in the Zahra suburb of Córdoba , were influential. Al-Zahrawi specialized in curing disease by cauterization . He invented several surgical instruments for purposes such as inspection of
16456-546: The World Health Organization has endorsed the Robson classification as a holistic means of comparing childbirth rates between different settings, with a view to allowing more accurate comparison of caesarean section rates. Antibiotic prophylaxis is used before an incision. The uterus is incised, and this incision is extended with blunt pressure along a cephalad-caudad axis. The infant is delivered, and
16643-401: The cervix , and cervical dilation occur during the closing weeks of pregnancy . Effacement is usually complete or near-complete and dilation is about 5 cm by the end of the latent phase. The degree of cervical effacement and dilation may be felt during a vaginal examination. The active phase of labour has geographically differing definitions. The World Health Organization describes
16830-771: The developing world . Complications in the mother include obstructed labour , postpartum bleeding , eclampsia , and postpartum infection . Complications in the baby include lack of oxygen at birth (birth asphyxia), birth trauma , and prematurity . The most prominent sign of labour is strong repetitive uterine contractions . Pain in contractions has been described as feeling similar to very strong menstrual cramps . Crowning may be experienced as an intense stretching and burning. The Lamaze method of childbirth teaches that making noises such as moaning, groaning, grunting, repeating words over and over, and any sound that one's body may wish to naturally make may help to relieve pain and help labour to progress. According to Lamaze, "While
17017-495: The placenta is then removed. The surgeon then makes a decision about uterine exteriorization. Single-layer uterine closure is used when the mother does not want a future pregnancy. When subcutaneous tissue is 2 cm thick or more, surgical suture is used. Discouraged practices include manual cervical dilation , any subcutaneous drain , or supplemental oxygen therapy with intent to prevent infection. Caesarean section can be performed with single or double layer suturing of
17204-422: The placenta or umbilical cord . A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary. A C-section typically takes 45 minutes to an hour. It may be done with a spinal block , where
17391-457: The risk of death for caesarean sections is 13 per 100,000 vs. 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. 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. The difference in in-hospital maternal death
17578-494: The shortening and opening of the cervix during the first stage, descent and birth of the baby during the second, the delivery of the placenta during the third, and the 4th stage of recovery which lasts until two hours after the delivery. The first stage is characterised by abdominal cramping or back pain that typically lasts around half a minute and occurs every 10 to 30 minutes. The contractions (and pain) gradually becomes stronger and closer together. The second stage ends when
17765-584: The umbilical cord for at least one minute or until it ceases to pulsate, which may take several minutes, improves outcomes as long as there is the ability to treat jaundice if it occurs. For many years it was believed that late cord cutting led to a mother's risk of experiencing significant bleeding after giving birth, called postpartum bleeding . However a recent review found that delayed cord cutting in healthy full-term infants resulted in early haemoglobin concentration and higher birthweight and increased iron reserves up to six months after birth with no change in
17952-411: The vaginal opening . This is assisted by the additional maternal efforts of pushing, or bearing down, similar to defecation . The appearance of the fetal head at the vaginal opening is termed crowning . At this point, the mother will feel an intense burning or stinging sensation. When the amniotic sac has not ruptured during labour or pushing, the infant can be born with the membranes intact. This
18139-435: The "mucus plug", a thick plug of mucus that blocks the opening to the uterus, is pushed out into the vagina. The mucus plug may become dislodged days before labour begins or not until the start of labour. While inside the uterus the baby is enclosed in a fluid-filled membrane called the amniotic sac . Shortly before, at the beginning of, or during labour the sac ruptures . Once the sac ruptures, termed "the water breaks",
18326-403: The 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment of injury and disability .". Obstetric care shares close ties with reproductive rights , which includes access to reproductive health. Surgeons and public health advocates, such as Kelly McQueen , have described surgery as "Integral to the right to health ". This is reflected in
18513-418: The 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $ 387 billion in hospital costs. The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals. Data from 2003 to 2011 showed that U.S. hospital costs were highest for
18700-724: The Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030. The Commission highlighted that about 5 billion people lack access to safe and affordable surgical and anesthesia care and 143 million additional procedures were needed every year to prevent further morbidity and mortality from treatable surgical conditions as well as
18887-734: The New European Surgical Academy, at the time he was the director of Misgav Ladach , a general hospital in Jerusalem. The method was presented during a FIGO conference in Montréal in 1994 and then distributed by the University of Uppsala, Sweden, in more than 100 countries. This method is based on minimalistic principles. He examined all steps in caesarean sections in use, analyzed them for their necessity and, if found necessary, for their optimal way of performance. For
19074-543: The Paliokastro on Thasos ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery. According to the researchers: "The very serious trauma cases sustained by both males and females had been treated surgically or orthopedically by a very experienced physician/surgeon with great training in trauma care. We believe it to have been
19261-482: The United States was 23.3%, and had more than doubled from 1990 to 2010. By 2022 it had climbed to 32%. The American Congress of Obstetricians and Gynecologists (ACOG) guidelines recommend a full evaluation of the maternal-fetal status, the status of the cervix, and at least a 39 completed weeks (full term) of gestation for optimal health of the newborn when considering elective induction of labour. Per these guidelines, indications for induction may include: Induction
19448-650: The World Bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment. In fact, a systematic review found that the cost-effectiveness ratio – dollars spent per DALYs averted – for surgical interventions is on par or exceeds those of major public health interventions such as oral rehydration therapy , breastfeeding promotion , and even HIV/AIDS antiretroviral therapy . This finding challenged
19635-431: The abdominal incision he used the modified Joel Cohen incision and compared the longitudinal abdominal structures to strings on musical instruments. As blood vessels and muscles have lateral sway, it is possible to stretch rather than cut them. The peritoneum is opened by repeat stretching, no abdominal swabs are used, the uterus is closed in one layer with a big needle to reduce the amount of foreign body as much as possible,
19822-552: The active first stage as "a period of time characterised by regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilatation from 5 cm until full dilatation for first and subsequent labours”. In the US, the definition of active labour was changed from 3 to 4 cm, to 5 cm of cervical dilation for multiparous women, mothers who had given birth previously, and at 6 cm for nulliparous women, those who had not given birth before. This
20009-556: The ancient land, called 'Alahana Pirivena' situated in Polonnaruwa, with ruins, was excavated. In that place ruins of an ancient hospital emerged. The hospital building was 147.5 feet in width and 109.2 feet in length. The instruments which were used for complex surgeries were there among the things discovered from the place, including forceps, scissors, probes, lancets, and scalpels. The instruments discovered may be dated to 11th century AD. In ancient Greece , temples dedicated to
20196-434: The anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. During the post-operative period, the person's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Obesity has long been considered
20383-577: The baby during the process of birth, and the mode of delivery (vaginal versus caesarean) is controversial in the fields of obstetrics and midwifery . Though vaginal birth is possible for the breech baby, certain fetal and maternal factors influence the safety of vaginal breech birth. The majority of breech babies born in the United States and the UK are delivered by caesarean section as studies have shown increased risks of morbidity and mortality for vaginal breech delivery, and most obstetricians counsel against planned vaginal breech birth for this reason. As
20570-405: The baby is at risk for infection and the mother's medical team will assess the need to induce labour if it has not started within the time they believe to be safe for the infant. The first stage of labour is divided into latent and active phases, where the latent phase is sometimes included in the definition of labour, and sometimes not. The latent phase is generally defined as beginning at
20757-401: The baby is born. As pressure on the cervix increases, a sensation of pelvic pressure is experienced, and, with it, an urge to begin pushing. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the pelvic inlet . The fetal head then continues descent into the pelvis, below the pubic arch and out through
20944-405: The birth canal. This change in the shape of the fetal head is called molding and is much more prominent in women having their first vaginal delivery. Cervical ripening is the physical and chemical changes in the cervix to prepare it for the stretching that will take place as the fetus moves out of the uterus and into the birth canal. A scoring system called a Bishop score can be used to judge
21131-555: The birthing process. Factors like pain in the first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labor and delivery. 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. Women who had just one previous caesarean section are more likely to have problems with their second birth. Delivery after previous caesarean section
21318-429: The case of back labour, that typically lasts half a minute and occurs every 10 to 30 minutes. Contractions gradually become stronger and closer together. Since the pain of childbirth correlates with contractions, the pain becomes more frequent and strong as the labour progresses. The second stage ends when the infant is fully expelled. The third stage is the delivery of the placenta . The fourth stage of labour involves
21505-423: 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
21692-1087: The common misconception that surgical care is financially prohibitive endeavor not worth pursuing in LMICs. A key policy framework that arose from this renewed global commitment towards surgical care worldwide is the National Surgical Obstetric and Anesthesia Plan (NSOAP). NSOAP focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. This approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. Successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support. Access to surgical care
21879-444: The degree of cervical ripening to predict the timing of labour and delivery of the infant or for women at risk for preterm labour. It is also used to judge when a woman will respond to induction of labour for a postdate pregnancy or other medical reasons. There are several methods of inducing cervical ripening which will allow the uterine contractions to effectively dilate the cervix. Vaginal delivery involves four stages of labour:
22066-414: The demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier , Padua and Bologna were particularly renowned. In the 12th century, Rogerius Salernitanus composed his Chirurgia , laying the foundation for modern Western surgical manuals. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as
22253-428: The duration of the third stage is longer than 30 minutes and raises concern for retained placenta . Placental expulsion can be managed actively or it can be managed expectantly, allowing the placenta to be expelled without medical assistance. Active management is the administration of a uterotonic drug within one minute of fetal delivery, controlled traction of the umbilical cord and fundal massage after delivery of
22440-494: The enjoyment of a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable health". Surgical care can be thereby viewed as a positive right – an entitlement to protective healthcare. Woven through the International Human and Health Rights literature is the right to be free from surgical disease. The 1966 ICESCR Article 12.2a described the need for "provision for
22627-554: The establishment of the WHO Global Initiative for Emergency and Essential Surgical Care in 2005, the 2013 formation of the Lancet Commission for Global Surgery, the 2015 World Bank Publication of Volume 1 of its Disease Control Priorities Project "Essential Surgery", and the 2015 World Health Assembly 68.15 passing of the Resolution for Strengthening Emergency and Essential Surgical Care and Anesthesia as
22814-485: The greatest surgeons of the ancient world and performed many audacious operations – including brain and eye surgery – that were not tried again for almost two millennia. Hippocrates stated in the oath ( c. 400 BCE ) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists Researchers from the Adelphi University discovered in
23001-467: The healer-god Asclepius , known as Asclepieia ( Greek : Ασκληπιεία , sing. Asclepieion Ασκληπιείον ), functioned as centers of medical advice, prognosis, and healing. In the Asclepieion of Epidaurus , some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place. The Greek Galen was one of
23188-630: The hospital shortly after birth and her midwife will continue her care at her home. In the U.S. the average length of stay has gradually dropped from 4.1 days in 1970 to a current stay of 2 days. The CDC attributed the drop to the rise in health care costs, saying people could not afford to stay in the hospital any longer. To keep it from dropping any lower, in 1996 congress passed the Newborns' and Mothers' Health Protection Act that requires insurers to cover at least 48 hours for uncomplicated delivery. In many cases and with increasing frequency, childbirth
23375-594: The hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. People who are frail and elderly (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. Surgery on children requires considerations that are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments. Bariatric surgery in youth
23562-445: The immune system, and poor digestive system. However, caesarean deliveries are found to not affect a newborn's risk of developing food allergy. This finding contradicts a previous study that claims babies born via caesarean section have lower levels of Bacteroides that is linked to peanut allergy in infants. Caesarean sections have been classified in various ways by different perspectives. One way to discuss all classification systems
23749-409: The indicated problem, minimize the risk of complications, optimize the time needed for recovery, and limit the surgical stress response. The intraoperative phase begins when the surgery subject is received in the surgical area (such as the operating theater or surgical department ), and lasts until the subject is transferred to a recovery area (such as a post-anesthesia care unit ). An incision
23936-409: The infant and parents with higher oxytocin levels showed more responsiveness and synchrony in their interactions with their infant. The act of nursing a child also causes a release of oxytocin to help the baby get milk more easily from the nipple. Station refers to the relationship of the fetal presenting part to the level of the ischial spines . When the presenting part is at the ischial spines
24123-409: The infant be placed on the mother's chest, termed skin-to-skin contact , and delaying routine procedures for at least one to two hours or until the baby has had its first breastfeeding. Definitions of the onset of labour include: Many women are known to experience what has been termed the "nesting instinct". Women report a spurt of energy shortly before going into labour. Common signs that labour
24310-399: The infant can be done while the infant remains close to the mother, saying that even a brief separation before the baby has had its first feed can disturb the bonding process. They further advise frequent skin-to-skin contact as much as possible during the first days after delivery, especially if it were interrupted for some reason after the delivery. La Leche League advises women to have
24497-408: The infant is fully expelled. In the third stage, the delivery of the placenta. The fourth stage of labour involves recovery, the uterus beginning to contract to pre-pregnancy state, delayed clamping of the umbilical cord , and monitoring of the neonatal tone and vitals. As of 2014, all major health organisations advise that immediately following a live birth , regardless of the delivery method, that
24684-427: The interior of the urethra and for removing foreign bodies from the throat, the ear, and other body organs. He was also the first to illustrate the various cannulae and to treat warts with an iron tube and caustic metal as a boring instrument. He describes what is thought to be the first attempt at reduction mammaplasty for the management of gynaecomastia and the first mastectomy to treat breast cancer . He
24871-490: The interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage . Whilst in surgery aseptic technique is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands. An antiseptic solution
25058-429: The latent first stage has not been established and can vary widely from one woman to another. However, the duration of active first stage (from 5 cm until full cervical dilatation) usually does not extend beyond 12 hours in the first labour("primiparae"), and usually does not extend beyond 10 hours in subsequent labours ("multiparae"). Dystocia of labour , also called "dysfunctional labour" or "failure to progress",
25245-487: The life of the woman or the fetus) or grade 1 (delivery required within 30 minutes of the decision: immediate threat to the life of the mother or the baby or both.) Elective caesarean sections may be performed on the basis of an obstetrical or medical indication, or because of a medically non-indicated maternal request . Among women in the United Kingdom, Sweden and Australia, about 7% preferred caesarean section as
25432-465: The likelihood and effectiveness of breastfeeding. As of 2014, early postpartum SSC is endorsed by all major organisations that are responsible for the well-being of infants, including the American Academy of Pediatrics . The World Health Organization (WHO) states that "the process of childbirth is not finished until the baby has safely transferred from placental to mammary nutrition." It
25619-415: The lower segment of the uterus. During a contraction, uterine muscles contract causing shortening of the upper segment and drawing upwards of the lower segment, in a gradual expulsive motion. The presenting fetal part then is permitted to descend. Full dilation is reached when the cervix has widened enough to allow passage of the baby's head, around 10 cm dilation for a term baby. A standard duration of
25806-501: The many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves. The second figure of importance in this era was Ambroise Paré (sometimes spelled "Ambrose" ), a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Paré began to employ
25993-401: The media would have you believe that all birthing women scream, in reality, it's not the most common noise." They say that screaming may be a sign that the labouring woman is beginning to panic and the support team should help her back to regulated breathing. Back labour is a complication that occurs during childbirth when a fetus exhibits posterior presentation (i.e. when the fetus is facing
26180-411: The most appropriate method of anaesthesia. The decision whether to perform general anesthesia or regional anesthesia (spinal or epidural anaesthetic) is important and is based on many indications, including how urgent the delivery needs to be as well as the medical and obstetric history of the woman. Regional anaesthetic is almost always safer for the woman and the baby but sometimes general anaesthetic
26367-636: The most basic emergency surgical care. In terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income. In alignment with the LCoGS call for action, the World Health Assembly adopted the resolution WHA68.15 in 2015 that stated, "Strengthening emergency and essential surgical care and anesthesia as
26554-444: The most frequent reason given. By 2018 the rate had climbed to one-third of all births. Obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour. Supportive care during labour may involve emotional support, comfort measures, and information and advocacy which may promote the physical process of labour as well as women's feelings of control and competence, thus reducing
26741-491: The mother include vaginal tearing, including a higher chance of having a more major vaginal tear that involves the muscle or wall of the anus or rectum. For women undergoing operative vaginal delivery with vacuum extraction or forceps, there is strong evidence that prophylactic antibiotics help to reduce the risk of infection. There is a higher risk of blood clots forming in the legs or pelvis – anti-clot stockings or medication may be ordered to avoid clots. Urinary incontinence
26928-416: The mother or hospital staff) or as a 'grade 3' section (no maternal or fetal compromise but early delivery needed). Emergency caesarean sections are performed in pregnancies in which a vaginal delivery was planned initially, but an indication for caesarean delivery has since developed. In the UK they are further classified as grade 2 (delivery required within 90 minutes of the decision but no immediate threat to
27115-399: The mother's navel), instead of the typical anterior presentation. This leads to more intense contractions, and causes pain in the lower back that persists between contractions as the fetus’ occiput exerts pressure on the mother's sacrum. Another prominent sign of labour is the rupture of membranes , commonly known as "water breaking". During pregnancy, a baby is surrounded and cushioned by
27302-600: The mother, with the baby occasionally surviving. A popular idea is that the Roman statesman Julius Caesar was born via caesarean section and is the namesake of the procedure, but if this is the true etymology, it is based on a misconception: until the modern era, C-sections seem to have been invariably fatal to the mother, and Caesar's mother Aurelia not only survived her son's birth but lived for nearly 50 years afterward. There are many ancient and medieval legends, oral histories, and historical records of laws about C-sections around
27489-431: 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
27676-508: The need for extended care. Assessment of older people before elective surgery can accurately predict the person's recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness , exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in
27863-738: The need for obstetric intervention. The continuous support may be provided either by hospital staff such as nurses or midwives, doulas , or by companions of the woman's choice from her social network. There is increasing evidence to show that the participation of the child's father in the birth leads to a better birth and also post-birth outcomes, providing the father does not exhibit excessive anxiety. Continuous labour support may help women to give birth spontaneously, that is, without caesarean or vacuum or forceps, with slightly shorter labours, and to have more positive feelings regarding their experience of giving birth. Continuous labour support may also reduce women's use of pain medication during labour and reduce
28050-440: The nursery and that the separation would offer the mothers more time to rest. As attitudes began to change, some hospitals offered a "rooming in" option wherein after a period of routine hospital procedures and observation, the infant could be allowed to share the mother's room. As of 2020, rooming-in has increasingly become standard practice in maternity wards. Skin-to-skin contact (SSC), sometimes also called kangaroo care ,
28237-412: The oesophagus in pregnancy, upward pressure of the uterus on the stomach, and the possibility of general anaesthetic in the event of an emergency cesarean. A 2013 Cochrane review found that with good obstetrical anaesthesia there is no change in harms from allowing eating and drinking during labour in those who are unlikely to need surgery. They additionally acknowledge that not eating does not mean there
28424-411: The other hand, VBAC confers less maternal morbidity and a decreased risk of complications in future pregnancies than elective repeat caesarean section. There are several 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: Despite these proactive measures, adhesion formation
28611-452: The peritoneal layers remain unsutured and the abdomen is closed with two layers only. Women undergoing this operation recover quickly and can look after the newborns soon after surgery. There are many publications showing the advantages over traditional caesarean section methods. There is also an increased risk of abruptio placentae and uterine rupture in subsequent pregnancies for women who underwent this method in prior deliveries. Since 2015,
28798-410: The person requiring surgery signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system , the person requiring surgery may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before
28985-585: The person who had surgery is discharged the same working day. Office-based surgery occurs in a physician's office, and the person is discharged the same day. At a hospital , modern surgery is often performed in an operating theater using surgical instruments , an operating table , and other equipment. Among United States hospitalizations for non-maternal and non-neonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures. The environment and procedures used in surgery are governed by
29172-565: The placenta, followed by performance of uterine massage every 15 minutes for two hours. In a joint statement, World Health Organization , the International Federation of Gynaecology and Obstetrics and the International Confederation of Midwives recommend active management of the third stage of labour in all vaginal deliveries to help to prevent postpartum haemorrhage . Delaying the clamping of
29359-428: The point at which the woman perceives regular uterine contractions . In contrast, Braxton Hicks contractions , which are contractions that may start around 26 weeks gestation and are sometimes called "false labour", are infrequent, irregular, and involve only mild cramping. Braxton Hicks contractions are the uterine muscles preparing to deliver the infant. Cervical effacement , which is the thinning and stretching of
29546-484: The postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period. Following the birth, if the mother had an episiotomy or a tearing of the perineum , it is stitched. This is also an optimal time for uptake of long-acting reversible contraception (LARC), such as the contraceptive implant or intrauterine device (IUD), both of which can be inserted immediately after delivery while
29733-413: The principles of aseptic technique : the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must be sterilized , and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). Operating room staff must wear sterile attire ( scrubs ,
29920-422: The procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the person is taken off ventilation and extubated (if general anesthesia was administered). After completion of surgery, the person is transferred to the post anesthesia care unit and closely monitored. When the person is judged to have recovered from
30107-423: The procedure it should be provided. If provided this should be done at 39 weeks of gestation or later. There is no evidence that ECS can reduce mother-to-child hepatitis B and hepatitis C virus transmission. Caesarean delivery on maternal request (CDMR) is a medically unnecessary caesarean section, where the conduct of a childbirth via a caesarean section is requested by the pregnant patient even though there
30294-505: The procedure, became significantly more common. Caesarean section (C-section) is recommended when vaginal delivery might pose a risk to the mother or baby. C-sections are also carried out for personal and social reasons on maternal request in some countries. Complications of labor and factors increasing the risk associated with vaginal delivery include: Other complications of pregnancy, pre-existing conditions, and concomitant disease, include: Other The prevalence of caesarean section
30481-444: The procedure. People preparing for surgery are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the person vomits during or after the procedure. Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice
30668-423: The rate of postpartum bleeding. The fourth stage of labour is the period beginning immediately after childbirth, and extends for about six weeks. The terms postpartum and postnatal are often used for this period. The woman's body, including hormone levels and uterus size, return to a non-pregnant state and the newborn adjusts to life outside the mother's body. The World Health Organization (WHO) describes
30855-451: The recovery of the mother, delayed clamping of the umbilical cord , and monitoring of the neonate . As of 2014, all major health organisations advise that immediately following a live birth , regardless of the delivery method, that the infant be placed on the mother's chest (termed skin-to-skin contact ), and to delay neonate procedures for at least one to two hours or until the baby has had its first breastfeeding . Vaginal delivery
31042-430: The recovery period. A recent post-operative care philosophy has been early ambulation. Ambulation is getting the patient moving around. This can be as simple as sitting up or even walking around. The goal is to get the patient moving as early as possible. It has been found to shorten the patient's length of stay. Length of stay is the amount of time a patient spends in the hospital after surgery before they are discharged. In
31229-461: The reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child" which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services". Article 12.2d of the ICESCR stipulates the need for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness", and is interpreted in
31416-447: The results of these tests can help evaluate surgical risk. A surgical team may include a surgeon, anesthetist, a circulating nurse, and a "scrub tech", or surgical technician, as well as other assistants who provide equipment and supplies as required. While informed consent discussions may be performed in a clinic or acute care setting, the pre-operative holding area is where documentation is reviewed and where family members can also meet
31603-401: The risk of babies having low five-minute Apgar scores. Eating or drinking during labour is an area of ongoing debate. While some have argued that eating in labour has no harmful effects on outcomes, others continue to have concern regarding the increased possibility of an aspiration event (choking on recently eaten foods) in the event of an emergency delivery due to the increased relaxation of
31790-523: The risk of local skin reactions or antibiotic resistance. Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. This "weekday effect" has been postulated to be from several factors including poorer availability of services on
31977-495: The short term, births with a planned caesarean were safer for babies than vaginal births. Fewer babies died or were seriously hurt when they were born by caesarean. There was tentative evidence that children who were born by caesarean had more health problems at age two. Caesareans caused some short-term problems for mothers such as more abdominal pain. They also had some benefits, such as less urinary incontinence and less perineal pain. The bottom-down position presents some hazards to
32164-443: The so-called "noninvasive surgery" ought to be more appropriately called minimally invasive procedures , which usually refers to a procedure that utilizes natural orifices (e.g. most urological procedures) or does not penetrate the structure being excised (e.g. endoscopic polyp excision , rubber band ligation , laser eye surgery ), are percutaneous (e.g. arthroscopy , catheter ablation , angioplasty and valvuloplasty ), or to
32351-481: The station is 0 (synonymous with engagement). If the presenting fetal part is above the spines, the distance is measured and described as minus stations, which range from −1 to −4 cm . If the presenting part is below the ischial spines, the distance is stated as plus stations ( +1 to +4 cm). At +3 and +4 the presenting part is at the perineum and can be seen. The fetal head may temporarily change shape (becoming more elongated or cone shaped) as it moves through
32538-456: The surgical service line; the surgical service line costs were $ 17,600 in 2003 and projected to be $ 22,500 in 2013. For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure. in 2012, mean hospital costs in the United States were highest for surgical stays. Older adults have widely varying physical health. Frail elderly people are at significant risk of post-surgical complications and
32725-439: The surgical site is anesthetized, but the person can remain conscious or minimally sedated. In contrast, general anesthesia may render the person unconscious and paralyzed during surgery. The person is typically intubated to protect their airway and placed on a mechanical ventilator , and anesthesia is produced by a combination of injected and inhaled agents. The choice of surgical method and anesthetic technique aims to solve
32912-423: The surgical team. Nurses in the preoperative holding area confirm orders and answer additional questions of the family members of the patient prior to surgery. In the pre-operative holding area, the person preparing for surgery changes out of their street clothes and are asked to confirm the details of his or her surgery as previously discussed during the process of informed consent. A set of vital signs are recorded,
33099-601: The surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading to abscess . Postoperative therapy may include adjuvant treatment such as chemotherapy , radiation therapy , or administration of medication such as anti-rejection medication for transplants. For postoperative nausea and vomiting (PONV), solutions like saline, water, controlled breathing placebo and aromatherapy can be used in addition to medication. Other follow-up studies or rehabilitation may be prescribed during and after
33286-713: The term "surgery" can also refer to the facility where surgery is performed, or simply the office / clinic of a physician , dentist or veterinarian . As a general rule, a procedure is considered surgical when it involves cutting of a person's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy , may be considered surgery if they involve "common" surgical procedure or settings, such as use of antiseptic measures and sterile fields, sedation / anesthesia , proactive hemostasis , typical surgical instruments , suturing or stapling . All forms of surgery are considered invasive procedures;
33473-418: The uterine incision. Single layer closure compared with double layer closure has been observed to result in reduced blood loss during the surgery. It is uncertain whether this is the direct effect of the suturing technique or if other factors such as the type and site of abdominal incision contribute to reduced blood loss. Standard procedure includes the closure of the peritoneum . Research questions whether this
33660-451: The uterus to prevent excessive blood flow, continue for several days. Vaginal discharge, termed "lochia", can be expected to continue for several weeks; initially bright red, it gradually becomes pink, changing to brown, and finally to yellow or white. At one time babies born in hospitals were removed from their mothers shortly after birth and brought to the mother only at feeding times. Mothers were told that their newborns would be safer in
33847-451: The woman is awake, or under general anesthesia . A urinary catheter is used to drain the bladder , and the skin of the abdomen is then cleaned with an antiseptic . An incision of about 15 cm (6 inches) is then typically made through the mother's lower abdomen. The uterus 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
34034-463: The woman is still in the delivery room. The mother has regular assessments for uterine contraction and fundal height , vaginal bleeding, heart rate and blood pressure, and temperature, for the first 24 hours after birth. Some women may experience an uncontrolled episode of shivering or postpartum chills following the birth. The first passing of urine should be documented within six hours. Afterpains (pains similar to menstrual cramps), contractions of
34221-481: The world shows an average of less than 1 day in Egypt to 6 days in (pre-war) Ukraine. Averages for Australia are 2.8 days and 1.5 days in the UK. While this number is low, two-thirds of women in the UK have midwife-assisted births and in some cases the mother may choose a hospital setting for birth to be closer to the wide range of assistance available for an emergency situation. However, women with midwife care may leave
34408-674: The world's population, with its core belief as the issues of need, access and quality". Halfdan T. Mahler , the 3rd Director-General of the World Health Organization (WHO) , first brought attention to the disparities in surgery and surgical care in 1980 when he stated in his address to the World Congress of the International College of Surgeons, "'the vast majority of the world's population has no access whatsoever to skilled surgical care and little
34595-573: The world, especially in Europe, the Middle East and Asia. The first recorded successful C-section (where both the mother and the infant survived) was performed on a woman in Switzerland in 1500 by her husband, Jakob Nufer , though this was not recorded until 8 decades later. With the introduction of antiseptics and anesthetics in the 19th century, survival of both the mother and baby, and thus
34782-468: Was done in an effort to increase the rates of vaginal delivery. Health care providers may assess the mother's progress in labour by performing a cervical exam to evaluate the cervical dilation, effacement, and station. These factors form the Bishop score . The Bishop score can also be used as a means to predict the success of an induction of labour . During effacement, the cervix becomes incorporated into
34969-426: Was not significant. 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
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