The Difficult Cesarean Delivery: Safeguards and Pitfalls

 

Rising numbers of Cesarean sections and maternal obesity and associated health risks have resulted in increasingly complex Cesarean deliveries and outcomes, requiring today’s surgeon to stay attuned to evolving best practices and master new surgical techniques. This first-of-its-kind reference provides step-by-step, highly illustrated guidance on managing challenging Cesarean sections with a focus on the challenges of abnormal placentation and strategies to manage it. In a concise, readable format, this text is designed to help surgeons anticipate intraoperative and postoperative challenges and optimize outcomes for mother and baby.

• Focuses on avoiding and managing surgical pitfalls and complications, providing safeguards and practical, hands-on guidance for surgeons at all levels of experience.
• Reviews the physiology of abnormal placentation (placenta accreta spectrum) and management of pre-delivery diagnosis, intraoperative and emergent abnormal placentation.
• Covers preparation and decision-making regarding type of incision, anesthesia, uterine conservation, management of acute post-procedure hemorrhage, intraoperative uterine artery catheterization and occlusion, and transarterial embolization.
• Includes special chapters on Peripartum Hysterectomy, Urologic and Gastrointestinal Injuries, Prerequisites for the Operative Suite, and two important imaging chapters on Diagnostic Imaging in Abnormal Placentation and the Role of Interventional Radiology.
• The digital version provides access to 11 surgical videos.

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Table of Contents:

 

Cover

Title Page

Copyright

Dedication

Contents

Contributors

Preface

Epigraph

1 The Impact of Cesarean Delivery on Maternal Mortality and Morbidity

2 The Obesity Epidemic

POTENTIAL COMPLICATIONS OF OBESITY IN PREGNANCY

CONCLUSION

3 Normal Physiology of Placentation

INTRODUCTION

PREIMPLANTATION

ANATOMY OF THE ENDOMETRIUM

STAGES OF IMPLANTATION

Stage 1: Apposition

Stage 2: Adhesion

Stage 3: Invasion and Uteroplacental Circulation

SECOND AND THIRD WEEK OF PLACENTAL DEVELOPMENT

Continuation of Vascular Development

EARLY PLACENTA FORMATION: IMPORTANCE OF VESSEL REMODELING

PLACENTAL DEVELOPMENT AND CHARACTERISTICS IN SECOND AND THIRD TRIMESTER

FUNCTIONS OF A NORMAL PLACENTA

PLACENTAL SEPARATION AND DELIVERY

Anatomy and Inspection of the Delivered Placenta

Further Inspection of Fetal Side and Maternal Side

SUGGESTED VIDEOS

4 Abnormal Placentation After Cesarean Delivery

INTRODUCTION AND STATISTICS

RISK FACTORS ASSOCIATED WITH CESAREAN MORBIDITY

IMPLANTATION SITES

TRANSVAGINAL ULTRASOUND AND IDENTIFICATION OF INTERNAL CERVICAL OS

MANAGEMENT DURING PREGNANCY

PLACENTA CRETA

Accreta Spectrum Pathology

Pathogenesis of Cretas

Radiological Signs of Cretas

UTERINE NICHE

Uterine Niche Management

CESAREAN SCAR PREGNANCY

Pathogenesis of Cesarean Scar Pregnancies

Ultrasound Diagnosis of Cesarean Scar Pregnancies

Differential Diagnosis of Cesarean Scar Pregnancy

5 Diagnostic Imaging in Abnormal Placentation

INTRODUCTION AND RESEARCH

INCIDENCE

ASSESSING FOR ABNORMAL PLACENTATION

RISK FACTORS FOR PAS AND SCREENING TO PREDICT WHO MAY BE AT RISK

ULTRASOUND: PRIMARY DIAGNOSTIC TOOL

Assessment of the Site of Implantation

CONFIRMING WITH USE OF COLOR FLOW DOPPLER

Uterovesical Hypervascularity

Bridging Vessels

Feeder Vessels

Lacunar Turbulent Flow

UTILIZING 3D ULTRASOUND IMAGING

3D Multislice View Doppler

MAGNETIC RESONANCE IMAGING

SUMMARY

6 Choice of Incisions: Obese Patient, Multiple Sections, and Abnormal Placentation

INTRODUCTION

SKIN INCISIONS FOR CESAREAN SECTION

Low Transverse Abdominal Incision

Midline Vertical Abdominal Incision

UTERINE INCISIONS

Lower Uterine Incision and Complications With Anterior Placentation

FUNDAL INCISIONS

Technique for Fundal Incision

Posterior Hysterotomy

SKIN INCISIONS IN THE OBESE PATIENT

Low Transverse Incision

Midline Vertical Incision

Supraumbilical Transverse Incision

Supraumbilical Longitudinal Abdominal Incision

7 Intraoperative Management of Accreta, Percreta, and Increta

INTRODUCTION

THE MULTIDISCIPLINARY TEAM AND PATIENT CONFERENCE

Other Team Members to Be Alerted and On-call

PLACENTA ACCRETA PLANNED DELIVERY

Preoperative Plan

Upon Admission

Intraoperative Management

Unplanned Delivery of Placenta Accreta with a Delivery Plan in Place

Unplanned Delivery of an Unknown Placenta Accreta

ACCRETA PROTOCOL

PLACENTA PERCRETA

DELAYED HYSTERECTOMY/FERTILITY SPARING SURGERY

STRATEGIES TO CONTROL BLOOD LOSS

Tranexamic Acid

Balloon Catheters

Uterine Artery Ligation

Hypogastric Artery Ligation

Postoperative Vessel Embolization Performed by Interventional Radiology

Abdominal Packing

8 Peripartum Hysterectomy

INTRODUCTION AND HISTORICAL PERSPECTIVE

Planned Versus Unplanned Peripartum Hysterectomy

PREOPERATIVE SURGICAL PLANNING

Facility and Team

Operative Suite and Equipment

CHOICE OF SKIN INCISION IN PERIPARTUM HYSTERECTOMY

Procedure for Converting from Pfannenstiel Incision to a Maylard Incision

Procedure for Converting from a Pfannenstiel Incision to a Cherney Incision

CHOICE OF UTERINE INCISION

New Technique Using a GIA Stapler to Make the Hysterotomy (Figures 8-4 and 8-5)

OPERATIVE TECHNIQUES FOR PERIPARTUM HYSTERECTOMY

Traditional Technique for Peripartum Hysterectomy

Complete Hysterectomy: Step-by-step Approach

MODIFICATIONS TO THE TRADITIONAL TECHNIQUE FOR PERIPARTUM HYSTERECTOMY

Preoperative Ureteral Catheter Placement

Elective or Opportunistic Salpingectomy

Modifications Using Vessel-Sealing Devices

Use of the Koh Cup Ring to Identify the Vaginal Fornix

MANAGEMENT OF BLADDER AND URETERAL INJURIES

MANAGEMENT OF INTRAOPERATIVE BOWEL INJURIES

9 Urologic and Gastrointestinal Injuries

BLADDER INJURY

Assessment for Bladder Injury

Repair of Injury to the Dome of the Bladder

Repair of Injury to the Trigone of the Bladder

URETER INJURY

Assessment for Ureteral Injury

Procedure for Repair of Injury to Ureter

Procedure for Cut or Damaged Ureter

Repair of Larger Ureteral Injury

PELVIC BRIM INJURY

Repair of Pelvic Brim Injury

BOWEL INJURY

Repair of Serosal Bowel Injury

Repair of Full-Thickness Bowel injury

Resection and Reanastomosis of the Small Bowel (Side-to-side, Functional End-to-end)

Resection and Reanastomosis of the Large Bowel

Colostomy or Ileostomy

UNRECOGNIZED INJURIES AND POSTOPERATIVE MANAGEMENT

10 Postoperative Management of the Difficult Cesarean Delivery

INTRODUCTION AND HISTORICAL PERSPECTIVE

ENHANCED RECOVERY AFTER SURGERY GUIDELINES AND PRINCIPLES

POSTOPERATIVE FLUID MANAGEMENT

ANALGESIA

Oral Analgesics

Transversus Abdominis Plane Blocks

VENOUS THROMBOEMBOLISM PREVENTION

MOBILIZATION

FOLEY CATHETER AND DRAINS

GLUCOSE CONTROL

SPECIFIC POSTOPERATIVE COMPLICATIONS

Anesthesia-Related Complications

Urinary Retention

Postdural Puncture Headache

Spinal Epidural Hematoma and Central Nervous System Infection

Postoperative Fever

Breast Engorgement, Infective Mastitis, Abscess

Endomyometritis

Septic Pelvic Thrombophletitis

Blood Transfusion Complications

Respiratory Complications

Bowel Complications

Renal Complications

Wound Complications

11 Anesthesia for the Difficult Cesarean Delivery

INTRODUCTION

PHYSIOLOGICAL AND ANATOMICAL CHANGES IN HEALTHY PARTURIENTS

ANESTHESIA CHALLENGES FOR THE HEALTHY PARTURIENT

MORBID OBESITY

THE OBSTETRIC DIFFICULT AIRWAY

Distance Measurement and Its Implications for Difficult Laryngoscopy and Intubation

PULMONARY CHANGES

CARDIAC CHANGES

GASTROINTESTINAL CHANGES

ANATOMICAL CHANGES FOR NEURAXIAL PLACEMENT

DIFFICULT INTRAVENOUS LINE PLACEMENT

CESAREAN SECTION ANESTHESIA FOR THE OBESE PARTURIENT

PREOPERATIVE PREPARATION

Intraoperative Neuraxial Management

POSTOPERATIVE MANAGEMENT

GENERAL ANESTHESIA

Preoperative General Anesthesia Considerations

Postoperative General Anesthesia Management

COMPLICATIONS OF HIGH-ORDER REPEAT CESAREAN SECTION

Anesthesia in Placenta Accreta Spectrum

Antepartum Consultation in Placenta Accreta Spectrum

Preoperative Preparation

Intraoperative Management

Postoperative Management

12 The Role of Interventional Radiology in the Management of the Difficult Cesarean Delivery

INTRODUCTION AND HISTORICAL PERSPECTIVES

PREDISPOSING CONDITIONS TO PERIPARTUM HEMORRHAGE

Placenta Accreta Spectrum

Uterine Atony

Genital Lacerations

DELIVERY PLANNING AND DELIVERY

Facility and Multidisciplinary Team

ENDOVASCULAR INTERVENTIONS

Embolization

Balloon Occlusion

13 Operative Suite Prerequisites for Successful Outcomes

INTRODUCTION

OPERATING ROOM FACILITY

INSTRUMENTS AND EQUIPMENT

Types of Retractors

Additional Instruments Needed From the Gynecology/Oncology Tray

Hemoclips

Automated Stapling Devices (Figure 13-7)

Suction Setups and Ring Forceps

Vascular Clamps (Figure 13-8)

Intra-abdominal packs

Availability of Mass Transfusion Products

MULTIDISCIPLINARY TEAM

Pelvic Surgeon

Interventional Radiologist

Index

 

An aparitie	1 Mar. 2020
Autor	Guy I. Benrubi
Dimensiuni	17.1 x 0.6 x 24.8 cm
Editura	Lippincott Williams and Wilkins
Format	Paperback
ISBN	9781975116675
Limba	Engleza
Nr pag	208