C-Section or C++?

Let us preface that although Dr.Fisher does not perform vaginal tightening or other reparative surgeries in the area, he has performed such operations in the past and has more experience in this respect than many of our patients might surmise. How does this connect to the latest news on the growing number of caesarian sections (currently over 30% of all births) in the United States?

We are excitedly awaiting the publication of the September issue of Obstetrics and Gynecology, where the conclusions of the latest studies on caesarian section procedures will be qualified for a larger public. In order to minimize the risk of infection in mothers, women giving birth to babies by caesarean section should routinely receive antibiotics an hour before the surgery, according to a new recommendation issued Monday by a national doctor group. Currently, women who undergo caesareans often receive antibiotics as a precaution against infection to the abdomen and uterus—but usually only after the delivery, when the umbilical cord is clamped, because of concern for the baby’s safety. Some pediatricians worry that antibiotics administered to the mother will reach the newborn and suppress the baby’s blood bacterial count, potentially masking a serious infection in the baby unrelated to the caesarean section. However, such worries might be untimely and unwarranted.

Dr.Fisher recommends taking antibiotics as preventative measure. “It is not the antibiotics that may cause problems, but the doctors who administer them,” he says. “A physician must be absolutely certain what the impact of a particular antibiotic is going to be, and what the appropriate dosage should be. It is also critical that each patient be completely honest with the physician about her diseases, past and present, and any ailments or maladies she may have had recently. A surgery is a surgery. We know that some 8% to 10% of women who have a scheduled caesarean will acquire an infection, as will about 30% of women who have a caesarean delivery after labor has begun, because of greater exposure of the inside of the uterus to bacteria from the vagina.”

Although the prevalence rates for sepsis do not appear to be significant in newborns, during plastic, and, in particular, reconstructive surgery, any “unaccounted for” bacteria may cause adverse reaction of the patient’s immune system to the implant. “There are no reliable studies on the subject out there,” says Dr.Fisher, “but, from my own experience – it is better to be safe than be sorry. If the implant is rejected, we have to wait for the body to recuperate, re-acquire full immunity, before we set things right… and this may be very traumatic for both the patient and the surgeon.”

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