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👶 | This husband is dangerous!Despair and trembling at the "reason why I can't take a day off from work" on the day of discharge ...! #Mama Senki XNUMX


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This husband is dangerous!On the day of discharge, I was desperate and trembled at the "reason why I couldn't take a day off from work" ...! #Mama Senki XNUMX

 
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Eight days after giving birth by Caesarean section, I called my husband to see if I could take a day off from the maternity hospital on the day I was discharged from the maternity hospital, but I was refused for an unexpected reason.
 

[Mama Senki] Episode 3Eight days after giving birth by Caesarean section, I called my husband to see if I could take a day off from the maternity hospital on the day I was discharged from the maternity hospital ... → Continue reading

 Baby calendar

The Baby Calendar provides daily information on topics related to pregnancy, pregnancy, childbirth, childrearing, infertility, and information useful for daily life that supports pregnant women, pregnant women, mothers raising children, and dads. I will. It is full of information taught by professionals in the fields of pregnancy, childbirth and childcare, such as registered dietitians and midwives.


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Discharge date

Caesarean section

Caesarean section(Caesarean section,British: caesarean section,Rice: cesarean section,alone: Kaiserschnitt) IsuterusBy incisionFetusTake out手術The method.JapanFor short, "Caesarean section"Or"KaiserIt is also called "C-section".

Etymology

Japanese"Caesarean section"16st centuryIt is thought that it was established around that timeFrenchof"opération césarienne"Latinof"sectio caesareaViaGermanof"KaiserschnittIs a literal translation.That GermanKaiserschnittIs the wordKaiser(emperor, Emperor)SectionIt is a compound word of (cutting, incision).ThatEtymologyHas a complicated background.

Ancient romeInRoman kingdomFrom the timeschildbirthOccasionally, if a pregnant woman dies, the "Orphans Law" stipulates that the abdomen should be incised and the foetation removed before burial.Lex CaesareaThere was a law called).The name means "cut out person" and the orphan is called Kaeso (caeso) Or Caesar (caesar) Is derived from the call.

On the other hand,OriginatorCaesar in a branch house as a "cut out person"Caesar) Was sometimes named.For exampleGaius Julius CaesarIs a prestigiousJulia gensIt is the name of the family that indicates that it is a branch of the family (the names of the ancient Romans are personal name → clan name → family name).

However,1st centuryToGreat PlinyIs the main work "Natural history』, Jokingly wrote as follows, which gave birth to the legend that" Caesar was born by Caesarean section ".

Caesar was obtained from the womb of the mother whose name was cut off (a caeso matris utero), and the family name also has a similar origin. — Great Pliny,Natural historyVolume 7, Chapter 9, Section 47

In the medicine at that time, it was impossible for both mother and child to be healthy by making an incision in the abdomen, and Caesar had been alive since he was alive.(English edition)Due to the existence of a letter addressed to Caesar, it is highly unlikely that Caesar was actually born by Caesarean section.Also, the Caesares are not the homes founded by Gaius Julius Caesar, and the family name has been around for a long time (by the way, his uncle is also the exact same name Gaius Julius Caesar), so in that sense as well. It's an impossible story.

7st century OfスペインでIsidoreIn "Etymology" written by, the causal relationship is reversed.[1]

The word Caesar comes from Julius.As soon as the civil war broke out, he gained the highest status as a Roman aristocrat.On the other hand, he was also called Caesar because he was pulled out of the cut (caeso) womb of his dead mother, or because he was a child with natural rich hair (caesarie).Since then, the emperors who succeeded him have also been called Caesar.The person removed from the excised uterus was to be called Caeso or Caesar. — Isidore, Etymology, Vol. 9, Chapter 3, Section 12

Since Isidore's etymology was often adopted as a source for posterity, the word caesar has both its original meaning and its erroneous origin.16st centuryLike following the technique of Caesarean section that was established after thatLatin Ofsectio caesareaIt is thought that it was linked to the name[2].

In addition, there are the following etymological theories that are currently considered to be incorrect.

  • ChugokuEmperorastrologyBecause the birthday was decided regardless of the condition of the mother and child, it is said that she gave birth by incision to protect her birthday.
  • ShakespeareDrama "MacbethThe King of Scotland, the main character ofMacbethAssassinated the former king and became the emperor. I was very pleased to hear the fortune-telling that "human beings born from the crotch of a woman will not be deprived of the throne of the emperor."However, when the sons of the former king collaborated with domestic aristocrats to fight to overthrow Macduff, and Macduff told the story of this fortune-telling during the duel with the enemy general Macduff, he told Macduff, "I am my mother. He was born hungry, "and was defeated, and the son of the former king became the new emperor.From the story.
  • ScissorsThe English scissors, which means, is pronounced "scissors."Caesarean section meant cutting the uterus with scissors, but the theory was that the word "caesarean section" was coined because the scissors were misread as Caesar (Caesar) in Rome.

History

It has long been a custom to remove a foetation from a dead mother.Greek mythologyThen the sun godApoloneIs a loverCoronisWas told of his unfaithfulness and killed her and was a foetation from the corpseAsclepiusIs said to have been taken out.The grown-up Asclepius became a well-known doctor who even revived the dead.ZeusBeing shot by the thunder and becoming a doctor's god.

Roman kingdomThen.7th century BC OfNuma PompiliusSince the Numa law enacted by the kingchildbirthFrom the body of the mother who died due toFetusIt was stipulated in the Orphans Law to take out.

Ancient egypt,Ancient greece,India,Africa OfEur-lex.europa.eu eur-lex.europa.euEven in ethnic minorities around the area, evidence of incision delivery has been found since ancient times.

Medieval europeEven inChristian churchRecommends an incision in a dead pregnant woman and advises her to keep her mouth open so that the foetation can breathe.

The oldest recorded Caesarean section is1500By Bauhin around the time,16st centuryBy Guillemeau[3]..However, at the time it was believed that the incised uterus should not be sutured, so in most casesPregnant woman TheBleedingdeaddid. A. CastiglioniMedical booksAccording to19st centuryIn the first half of the year, the mortality rate of Caesarean section was about 75%.[4].

1606Shakespeare's play "MacbethThe key to the story is that the aristocrat McDuff was born by Caesarean section.

1876,イタリアEdoardo Polo succeeded in saving the lives of both mother and child.This is 25 years oldpelvisA narrow pregnant woman was operated on because she couldn't deliver even after 4 weeks after the scheduled date.uterusIt was linked to hemostasis by excising the.further1881ToGermanyHe devised a surgical procedure to suture the incised uterus without removing it.

20st centuryEnterSterilizationWith the discovery of the law and thorough surgical management, the mortality rate has dropped to 2% to 3%.ObstetricsIt has reached the present as an operation that can be said to be the foundation of.

Incidentally,Ectopic pregnancyAgainst the burst ofThe United Kingdom"Father of modern surgery"1883, BurstedFallopian tubeSucceeded in the surgical procedure by excision of.

The first Caesarean section in JapanBakumatsuPeriod, currentSaitamaHannoWas carried out in[5].Edo PeriodTerminalKaei4 years(1852) On June 6, Saitama Prefecture said he was a doctor living in Hanno.Chichibu CityWas a doctorJunmichi IkodaTranslated into Japanese by NetherlandsIt took about an hour with the farmer's wife, Mito Motohashi (1 years old at the time), with reference to the medical book.FetusAlreadyDeathHowever, the mother's uterus was left as it was and only the abdomen was sutured.Mito remained in the pain of an infectious disease for about two months after the operation, but her life was saved and she lived until she was 2 years old.The room where the surgery was performed still exists in the Motohashi family.June 88, 1987 in the garden,Japan Medical History SocietyA monument was built by the company, and it is a place to pray for safe delivery.[6].

method

Abdominal caesarean section
Currently the most common method.The operation time is usually less than 1 hour, and usually about 2 hours at the longest.An example of the technique is described below.麻 酔Is usually performed with lumbar spinal anesthesia, but in an emergency it is general anesthesia.childbirthPregnant women in the period are regarded as full stomach, and Crush Induction, a special case without mask ventilationtracheaThe intubation method is used.All anestheticsplacentaCaesarean section under general anesthesia is a battle against time because it passes through and affects the foetation.
  1. Skin incision
    There are "vertical incision (midline incision)" and "horizontal incision".In the past, there were many "vertical incisions", but nowadays, "transverse incisions" are increasing with the expectation of reducing the burden during recovery from a cosmetic point of view. The "transverse incision" is consistent with the skin secant and the upper edge of the symphysis pubispubic hairTo make an incision near the top ofビ キ ニSurgical scars are less noticeable even when wearing clothes with a lot of exposed lower abdomen.The longitudinal incision is a little easier to operate, and the emergency caesarean section is usually a longitudinal incision.
  2. Incisions in the subcutaneous tissue, fascia, and peritoneum
    Make an incision in the adipose tissueRectus abdominal musclesThe anterior lobe of the sheath is exposed, and after the incision, the rectus abdominis muscle called the white lineFasciaDissociate the rectus abdominis muscle from the centrally located fascial tissueperitoneumTo expose.In the case of intraperitoneal cesarean section, a longitudinal peritoneal incision is performed to enter the abdominal cavity, and after a bladder-uterine peritoneal incision is performed.bladderIs peeled down to fully expose the lower part of the uterus.For extraperitoneal caesarean section, without peritoneal incisionbladderPeel off.
  3. Uterine myotomy
    CervixA transverse incision is made slightly above the uterine body (transverse incision in the lower segment of the uterine body).Longitudinal incision (classical uterine body incision)Pregnancy after cesarean sectionIs prone to "uterine rupture".A longitudinal incision is made in the case of placenta previa with anterior wall attachment, such as when avoiding the placenta accreta or during premature delivery less than 30 weeks gestation.
  4. Fetal delivery
    Hold the foetation and if it is in the head position, push the bottom of the uterus to remove it.Pelvic positionIf so, slowly pull it out from the buttocks.umbilical cordLigs (stops blood flow) and promptly hands the baby to a nurse, midwife, pediatrician, etc. who was waiting in the operating room.
  5. Uterine contents removal
    placentaRemove the uterine contents, including.A large amount of bleeding occurs in the uterus during uterine incision-fetal delivery-removal of uterine contents (usually)Amniotic fluidAbout 1L to 2L including the amount).Uterotonic agents generally as needed (mostly in recent yearsOxytocin) Is often injected.In many cases graduallyuterusWhen the uterus contracts and hardens and bleeding from the uterus stops, but the uterus does not contract and bleeding continues, it is a condition called "relaxation bleeding", and emergency total hysterectomy should be considered. I will do it.If the diagnosis and response to flaccid bleeding are delayed, heavy bleeding often leads to death.Therefore, in the case of scheduled Caesarean section, autologous blood storage is often performed before surgery.
  6. Uterine muscle suture
    The muscular layer is sutured in one or two layers.The bladder, uterine fossa and peritoneum are often sutured and closed.
  7. Hemostasis confirmation / intraperitoneal lavage
    After suturing the uterus, check for adequate hemostasis.Then warm the abdominal cavityraw foodWash with and attach an adhesion-preventing absorbent barrier (trade name "Seprafilm" "Interseed") to the uterus.Expensive but effective in preventing peritoneal adhesions (Health insuranceApplication).
  8. Peritoneum / subcutaneous tissue / skin suture
    Suture in the reverse order of the incision.
Vaginal caesarean section
Mid-pregnancy intrauterine fetal death and mid-termAbortionAt that time, it was done in the past.It is rarely done now.

Adaptation

In vaginal delivery, it is indicated (option) when there is a risk of maternal or fetal life, and some are absolutely indicated (required).

Indications are cases where rapid delivery is required but vaginal delivery is not possible, or vaginal delivery is not possible for physical reasons.Birth canal infectionMay be at high risk.In general, the following conditions are often indicated.

Status of each country

who(WHO) warns that there are many cases where a Caesarean section is required but not performed, and there are many cases where it is not necessary and is selected.[7].

birthThe ratio of Caesarean section to the total number is 24.8% in general hospitals in Japan (Ministry of Health, Labor and WelfareInvestigate)The United States of America,イタリア,People's Republic of ChinaIs in the 30% range.On the contraryBrazilWas high, rising from about 2000% in 38 to about 2015% in 56.The background is the doctor's compensation system, which is determined not by the time of witnessing the birth but by the number of times, and the doctor and pregnant women.カ ー ニ バ ル,ChristmasIt has been pointed out that there is a tendency to want to finish giving birth before taking a vacation, and there is a shortage of midwives.[8].

prognosis

Surgical results

With the completion of the surgical procedure, the maternal mortality rate of the Caesarean section itself is extremely low, but it is still 4 to 10 times that of vaginal delivery.Also, due to long-term rest after surgeryPulmonary embolismThe risk ofTherefore, in principle, early getting out of bed and early walking (within 24 hours after surgery).Hemo-concentration by infusionRed blood cell(Increase in concentration) is also prevented.

Vaginal delivery after cesarean section

Pregnant women who have had a Caesarean delivery in the past will usually be delivered by Caesarean section without performing the usual "vaginal delivery".A vaginal delivery trial of a pregnant woman who has had a cesarean delivery in the past is called a "trial of labor after cesarean section (TOLAC)", and the frequency of uterine rupture during delivery is rather high. It gets higher.Therefore, any TOLAC should be done after preparing for a Caesarean section (double set-up).

Caesarean section scar syndrome

Blood accumulates in the recessed uterine wound at the time of cesarean section (recessive scar on the uterine wound after cesarean section), causing various symptoms.SymptomsMenstruationDifficult, excessive menstruation,infertilityetc.ovulationInfertility occurs when blood accumulates in the uterine body during the period.Treatment isEndoscopeIt is to perform repair surgery at.In JapanToyama Prefectural Central HospitalRestoration was first performed in obstetrics and gynecology, and cases of pregnancy have been reported.Overseas, it was said that menstrual blood was trapped in the recess,ScarThe hospital proved that it was bleeding from itself.

footnote

[How to use footnotes]
  1. ^ This statement is doubly misleading as a statement for Julius Caesar, who was famous for his thinning hair.Isidore, Etymology, Vol. 9, 3:12.http://penelope.uchicago.edu/Thayer/L/Roman/Texts/Isidore/9*.html#3.12
  2. ^ Kiyoshi Tachikawa, "Medical Language Source Dictionary" p644
  3. ^ Kiyoshi Tachikawa, "Medical Language Source Dictionary" p644
  4. ^ Teizo Ogawa, "The Origin of Medical Terms" p19 (Tokyo Shoseki, 1990)
  5. ^ Saitama Prefecture's proud story --Saitama Prefecture. (July 2015, 7), viewed June 23, 2016.
  6. ^ "Saitama / Hanno Edo period, Japan's first Caesarean section / local doctor, relying on orchid books""Tokyo Newspaper] Morning issue December 2018, 10 (30 pages) Read December 28, 2018.
  7. ^ WHO warns against the global "spread" of Caesarean sectionAgence France-Presse (AFP)2015 4 Month 12 Day.
  8. ^ [World deep in-depth] "Caesarean section power" Brazil / Priority given to doctors' convenience 56% of births "Yomiuri Shimbun" morning edition December 2017, 12 (international).

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