Cesarean section or C-section is a surgical method of delivering a baby. A cut is made across the belly just above the pubic area. A horizontal incision is made in the lower uterine portion. LSCS - Lower segment Cesarean section is the preferred type of Cesarean surgery today as it allows the uterus to remain strong for future childbirth. The uterus is opened along with the amniotic sac and the baby is delivered. This is resorted to when a vaginal delivery is not possible; either because of risk to the mother or baby. Typical cases where Cesarean section is opted for are fetal distress, breech baby, uterine rupture, prolonged labor, hypertension in mother, tachycardia in mother or child or contracted pelvis. In cases of twin pregnancy or triplets, Cesarean section is opted. When the baby's heart rate is abnormally high or the baby has developmental problems, the obstetrician might suggest a c-section. But being a surgical procedure, Cesarean section carries some amount of risk. There can be chances of hemorrhage leading to anemia or need for blood transfusion. There is risk of infection at incision site or injury to other organs. The recovery time is longer than a normal vaginal delivery.
Addison's disease also known as chronic adrenal insufficiency is a hormonal disorder characterized by tissue necrosis and granulomatous appearance. Addison's disease occurs to people irrespective of age and gender. Addison's disease is also known as hypocortisolism as it is associated with insufficient production of cortisol from the adrenal glands.
Cortisol belongs to the class of glucocorticoid hormones. They are released from the cortex of the adrenal glands located on top of the kidneys. Cortisol has a significant function in the body and is associated with main organ system functions in maintaining the homeostasis in the body. Cortisol is essential in protein, carbohydrate and fat metabolism. It also helps in the regulation and release of insulin for blood sugar balance.
The other important functions of cortisol include maintenance of blood pressure, cardiovascular activity and inflammatory response process associated with the immune system. The level of cortisol in the body is used as a determination of stress management. Cortisol has precursors for its release such as the adrenocorticotropic hormone released due to the stimulus associated with the hypothalamus and pituitary gland.
Addison's disease etiology is predominantly based upon the function of the adrenal gland and the release of cortisol regulated by the pituitary gland. Insufficient cortisol production may be due to impairment of adrenal glands which is categorized as the primary phase in Addison's disease occurrence. The secondary factors are associated with release of adrenocorticotropic hormone levels from the pituitary gland to stimulate the adrenal gland. The tertiary factors are associated with insufficient release of corticotrophin releasing hormone from the hypothalamus.
Significant clinical manifestations include anorexia, vomiting, hypoglycemia, weight loss, cutaneous and mucosal pigmentation, hypernatremia, hyperkalemia, hypotension caused due to extra cellular fluid loss. Excess melanin production is observed along with visible changes in the surfaces of lips and buccal mucosa. Addison's disease can also occur because of preexisting factors such as tuberculosis, histoplasmosis, coccidioiodomycosis , autoimmune diseases and conditions associated with bilateral metastases, hemorrhages, amyloidosis and adrenoleukodystrophy.
Diagnosis of Addison's disease
Addison's disease is diagnosed by clinical symptoms which are correlated with biochemical laboratory tests. The levels of sodium, potassium and other important parameters with respect to inflammatory response and hormonal levels can diagnose the presence of Addison's disease. One of the significant diagnostic tools used to detect the presence of Addison's disease is the ACTH (adrenocorticotropic hormone stimulation test). In this test, ACTH is given intravenously to the patient and the levels of cortisol in urine and blood are examined. This test determines adrenal insufficiency factor.
Addison's disease and pregnancy
Steroid hormone balance and support aids labor and fetal development. Insufficiency of steroid hormones can affect the pregnancy especially during a cesarian. Conditions associated with Addison's disease may increase under situations of emergency. This is because of lack of steroid production in the body. Symptoms such as colds, confusion, increased weakness and fatigue can occur; which may become fatal if untreated.
Diet for Addison's disease
Patients with Addison's disease express cravings for salty food or foods that have citrus flavor. Sufficient intake of proteins balanced with vitamins and minerals is advisable. Many patients suffer dehydration; hence increased fluid intake is advised. Diet patterns can be altered in patients having conditions such as diabetes, hypertension and osteoporosis.
Treatment for Addison's disease
Hydrocortisone and fludrocortisone are generally used to replace the cortisol and aldosterone hormones in cases of adrenal insufficiency. Other options used are prednisone, dexamethasone with slow and sustained release characteristics. The advisable dosage for these steroid hormones is thrice a day to meet with the energy demands and activity of the individual.
The placenta usually separates from the uterus after the birth of the baby. Placental abruption is a condition where the placenta separates from the uterine wall during the pregnancy. Placental abruption is a serious condition and can put the baby at risk. This is a medical emergency. Hypertension can sometimes lead to placental abruption. Women who have blood-clotting disorders may experience placental abruption. Women suffering from diabetes or abusing drugs are also at higher risk for placental abruption. Those women who have had multiple pregnancies are also at higher risk for placental abruption.
A pregnant woman suffering from placental abruption is likely to have abdominal and back pain. There might be rapid uterine contractions. There is tenderness in the abdomen. Uterine bleeding is often noticed. Placental abruption can occur anytime after the 20th week of pregnancy.
An ultrasound can help in locating any possible blood clot behind the placenta. It can also help in checking for any signs of fetal distress. Fetal monitoring is essential since the placenta supplies nutrients to the growing fetus. There may be decreased fetal movements. The extent of placental abruption decides the course of treatment to be followed. Partial placental abruption needs adequate bed rest and close monitoring. In cases of total placental abruption, delivery of the infant is undertaken. This is either with vaginal delivery or cesarian section. But there is a risk of premature birth and fetal death. The newborn baby could suffer brain damage due to low levels of oxygen in the blood.
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Bibliography / Reference
Collection of Pages - Last revised Date: September 15, 2019