implication Gulardi H. Wiknjosastro Bagian Obstetri Ginekologi FKUI RS Dr. Cipto Mangunkusumo Jakarta History Caesarean Mitos : J. caesar dilahirkan dari ibu Aeralius The extraction of Asclepius from the abdomen of his mother Coronis by his father Apollo. Woodcut from the 1549 edition of Alessandro Beneditti's De Re Medica. History J. Caesar melakukan invasi ke Inggeris, Ibu merestuinya One of the earliest printed illustrations of Cesarean section. Purportedly the birth of Julius Caesar. A live infant being surgically removed from a dead woman. From Suetonius' Lives of the Twelve Caesars, 1506 woodcut. Developing country Seksio dilakukan pada ibu yang sekarat/meninggal Successful Cesarean section performed by indigenous healers in Kahura, Uganda. As observed by R. W. Felkin in 1879. Embriotomi Craniotomy. Perforation of the skull, removal of cranial contents, and extraction of the collapsed skull. Fetal malformation < 28 week pregnancy DIC Philosophy : The procedure should be on scientific base , for the sake/benefit of the patient and with least burden. Risk
Risk of maternal death due to CS
Trend of rising CS rate Belanda dengan angka seksio yang rendah mempunyai angka kematian ibu dan perinatal yang rendah di dunia Dikutip dari: E.J . Quilligan, 2001 Dikutip dari: E.J . Quilligan, 2001 Indication of CS by country
Indikator plasenta previa USG pada kehamilan > 37 mgg Dikutip dari: Cuningham dkk, 2001 The use of PARTOGRAM
CPD head or abdominal circumference of >35 cm; Contracted pelvis (Ro or CT) - incidence of 1% Malpresentation - posterior occiput Malposisi Risk of laceration U incision is the best avoiding the vessels Hemostatic stitch perpendicular to the vessels Dikutip dari: Cuningham dkk, 2001 Lebih baik dengan cara avue : Gunting arah keatas ! Bentuk U Hindari pelebaran tumpul mencapai vasa uterina Dikutip dari: Cuningham dkk, 2001
Dikutip dari: Cuningham dkk, 2001 Severe Preeclampsia FDJP /Biophysical profile < 6 CTG : Severe deceleration, non reactive Thick meconium Placental Insufficiency : Postterm > 42 mgg Prolaps t.pusat READY FOR RESCUCITATION PROBLEM laceration hematoma Bleeding from LS
Delivery of infant
placenta di depan PREVENTION Uincision Hemostatic stitches Stitches, tampon
forsep, vacuum, extraction insisi longitudinal rdh Robekan Hematoma Perdarahan dari insersi Atonia Kesulitan pengeluaran kepala Malposisi kepala Dikutip dari:W.C. Wong et al 2001 Low longitudinal Incision Indication :
preterm Placenta previa in anterior Shoulder pres.
Emergency CS INDIKASI: Keadaan umum buruk, risiko anestesi umm/regional CARA: Infiltrasi lidokain 0.5% , Atau: ketamin 50 mg bolus + Tetes Ketamin 100 mg/500 RL Spinal is the best Antiseptic Universal precaution Facilities, vital monitoring recording
Dikutip dari: E.J . Quilligan, 2001 Dikutip dari: E.J . Quilligan, 2001 Trends Amerika berusaha untuk mencapai tingkat angka seksio 15% Dikutip dari: Cuningham dkk, 2001 When is it safe for next pregnancy ? Risik of uterine rupture will increase if interval is less than 18 months. Evaluation of the thickness of low segmen at term. Rozenberg (1996): risk of uterine rupture increase if < 3.5 mm sensitifity 88%, specificity 99%. VBAC RATE Rebound effect Due to rate of CS VBAC
Dikutip dari: Cuningham dkk, 2001 Contraindication for VBAC Contracted pelvis Macrosomia Classic incision or deep myomectomy Overdistended Readiness for emergency CS (?) Dikutip dari: E.J . Quilligan, 2001
Dikutip dari: Cuningham dkk, 2001
Dikutip dari: Cuningham dkk, 2001 INFORMED CONSENT Information on indication, risk and benefit AUDIT Regular Maternal Perinatal meeting (weekly/monthly) Review for indications (e.g fetal distress) Morbidity Guidelines (EFM) May reduce the rate Report and dissemination
Model sistem skoring 0 1 prediksi keberhasilan P4S adalah 16% - 33% 2 3 prediksi keberhasilan P4S adalah 54% - 82% 4 5 prediksi keberhasilan P4S adalah 92% - 96%