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4: Y4 - Obstetrics [13] > [46] Caesarean Section > Flashcards

[46] Caesarean Section Flashcards

1
Q

What is a Caesarean section?

A

The delivery of a baby through a surgical incision in the abdomen and uterus

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2
Q

What % of deliveries in England are by c-section?

A

25%

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3
Q

What is caesarean section regionally associated with?

A

Local deprivation and individual social class

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4
Q

What factors affect the likelihood of caesarean section?

A
  • Place of birth
  • Induction of labour beyond 41 weeks in uncomplicated pregnancy
  • Consultant obstetrician involved in decision making
  • Electronic fetal monitoring
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5
Q

How does place of birth affect likelihood of Caesarean section?

A

Planned home delivery or in a midwifery-led unit reduces likelihood

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6
Q

How does induction of labour beyond 41 weeks affect likelihood of Caesarean section?

A

Reduces the risk of perinatal mortality and therefore Caesarean section

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7
Q

How does the involvement of consultant obstetricians in decision making affect the likelihood of Caesarean section?

A

Reduces it

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8
Q

How does electronic fetal monitoring affect the likelihood of Caesarean section?

A

Increase it

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9
Q

How can the planning of Caesarean section be classified?

A
  • Elective (planned)

or

  • Emergency
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10
Q

How may categories of emergency Caesarean section are there?

A

4

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11
Q

Why are there different categories of emergency Caesarean section?

A

To ensure babies are delivered in a timely manner in accordance to their or their mothers needs

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12
Q

What is a category 1 emergency Caesarean section?

A

Where there is immediate threat to life to the woman or fetus and baby should be born within 30 minutes

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13
Q

What is a category 2 emergency Caesarean section?

A

Where there is maternal or fetal compromise that is not immediately life threatening and baby is usually born within 60-75 minutes

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14
Q

What is a category 3 emergency Caesarean section?

A

No maternal or fetal compromise but early delivery is needed

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15
Q

What is a category 4 emergency Caesarean section?

A

Where delivery is timed to suit the woman or staff

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16
Q

What are the indications for a category 1 emergency Caesarean section?

A
  • Cord prolapse

- Fetal distress in the first stage

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17
Q

What are the possible indications for category 2 emergency Caesarean section?

A
  • Failure to progress

- Transverse lie in labour

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18
Q

What are the most common reasons for emergency Caesarean section?

A
  • Failure to progress

- Suspected/confirmed fetal compromise

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19
Q

What are the most common indications for elective (or emergency) Caesarean section?

A
  • Breech presentation
  • Other forms of malpresentation
  • Twin pregnancy
  • Maternal medical conditions
  • Fetal compromise
  • Transmissible disease
  • Primary genital herpes in third trimester
  • Placenta praevia
  • Maternal diabetes
  • Previous shoulder dystocia
  • Previous 3rd/4th degree perineal tear
  • Maternal request
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20
Q

What other malpresentations can be an indication for Caesarean section?

A
  • Unstable lie
  • Transverse lie
  • Oblique lie
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21
Q

What is unstable lie?

A

A presentation that fluctuates between oblique/cephalic/breech/transverse etc.

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22
Q

When is twin pregnancy an indication for Caesarean section?

A

When the first twin is not cephalic presentation

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23
Q

When are maternal medical conditions an indication for Caesarean section?

A

When labour would be dangerous for the mother

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24
Q

When is fetal compromise an indication for Caesarean section?

A
  • Early onset growth restriction
  • Abnormal fetal Doppler
  • When thought fetus would not cope with labour
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25
Q

What is an example of a transmissible disease that would be an indication for Caesarean section?

A

Poorly controlled HIV

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26
Q

Why is primary genital herpes in the third trimester an indication for Caesarean section?

A

There has been no time for development and transmission maternal antibodies to HSV to cross the placenta and protect the baby

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27
Q

When is maternal diabetes an indication for Caesarean section?

A

When baby is estimated to have fetal weight >4.5kg

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28
Q

When is a previous 3rd/4th degree perineal tear an indication for Caesarean section?

A

When the patient symptomatic and there is appropriate assessment

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29
Q

What does ‘maternal request’ mean ash indication for Caesarean section?

A

A variety of reasons from previous traumatic birth to ‘maternal choice’

30
Q

What should be conducted before a Caesarean section on maternal request is decided on?

A
  • MDT approach and counselling by a specialist midwife
31
Q

What steps should be taken before a Caesarean section?

A
  • FBC and G&S
  • H2-receptor antagonist prescribed +/- metoclopramide
  • Risk core for VTE
32
Q

Give an example of a H2-receptor antagonist?

A

Ranitidine

33
Q

What is metoclopramide?

A

An anti-emetic that increases gastric emptying

34
Q

Why should women having caesarean section have ranitidine +/- metoclopramide?

A

They are at risk of Mendelson’s syndrome

35
Q

What is Mendelson’s syndrome?

A

Aspiration of gastric contents into the lung

36
Q

What can Mendelson’s syndrome lead to?

A

Chemical pneumonitis

37
Q

Why are women having caesarean section at risk of Mendelson’s syndrome?

A

When they are lying flat there is pressure applied by the gravid uterus on the gastric contents

38
Q

What can be prescribed as part of thromboprophylaxis in Caesarean section?

A
  • TED stockings

- Low molecular weight heparin

39
Q

What type of anaesthesia are most Caesarean sections performed under?

A

Regional anaesthesia

40
Q

What types of regional anaesthesia are used in Caesarean section?

A
  • ‘Topped up’ epidural

- Spinal anaesthetic

41
Q

When might general anaesthetic be required in Caesarean section?

A
  • Maternal contra-indication to regional anaesthetic
  • Failure of regional anaesthetic to achieve required block
  • Concerns about fetal wellbeing and need to expedite delivery as soon as possible often in the case of category 1 sections
42
Q

How is the woman positioned during a Caesarean section?

A

With a left-lateral tilt of 15 degrees

43
Q

Why is the woman positioned at a 15˚ angle in Caesarean section?

A

To reduce the risk of supine hypotension due to aorta-caval compression

44
Q

What happens to the bladder in preparation for a Caesarean section?

A

Insert Foley’s catheter to drain the bladder

45
Q

Why is it important to catheterise patients having Caesarean section?

A

To reduce the risk of bladder injury

46
Q

What happens prior to ‘knife-to-skin’ incision?

A
  • Skin prepped with anti-septic

- Antibiotics administered

47
Q

What is the first step in a standard Caesarean section?

A

Create a skin incision (usually a transverse lower abdominal skin incision)

48
Q

What is the second step in a standard Caesarean section?

A

Sharp or blunt direction into the abdomen

49
Q

What layers must be dissected through to reveal the uterus in Caesarean section?

A
  • Skin
  • Camper’s fascia
  • Scarpa’s fascia
  • Rectus sheath
  • Rectus muscle
  • Abdominal peritoneum
50
Q

What is Camper’s fascia?

A

Superficial fatty layer of subcutaneous tissue

51
Q

What is Scarpa’s fascia?

A

Deep membranous layer of subcutaneous tissue

52
Q

What forms the rectus sheath?

A

The anterior and posterior leaves laterally coming to merge medially

53
Q

What is the third stage of a standard Caesarean section?

A

Incision is made in the visceral peritoneum covering the lower segment of the uterus and pushed down to reflect the bladder

54
Q

What is the 4th step of a standard Caesarean section?

A

Uterine incision made on lower uterine segment beneath the line of peritoneal reflection

55
Q

What is the 5th step of a standard Caesarean section?

A

Baby delivered cephalic/breech with fundal pressure from the assistant

56
Q

What is the 6th step of a standard Caesarean section?

A

Oxytocin 5iu is given IV to aid delivery of the placenta by controlled cord traction by the surgeon

57
Q

What is the 7th step of a standard Caesarean section?

A

Uterine cavity is ensured empty the closed, rectus sheath is closed and then the skin either with continuous/interrupted sutures or staples

58
Q

What should be monitored post-Caesarean section?

A
  • Observations on EWS

- Lochia (per vaginal blood loss post delivery)

59
Q

What is important to improve recovery time in Caesarean section?

A

Early mobilisation, eating, drinking and catheter removal

60
Q

What are the advantages of a primary Caesarean section?

A

Reduced risk of:

  • Perineal trauma and tear
  • Urinary and anal incontinence
  • Utervovaginal prolapse
  • Late stillbirth
  • Early neonatal infections
61
Q

What are the potential immediate complications in Caesarean section?

A
  • Postpartum haemorrhage
  • Wound haematoma
  • Intra-abdominal haemorrhage
  • Bladder/bowel trauma
  • Neonatal complications
62
Q

What amount of blood loss would be considered post-partum haemorrhage?

A

> 1000ml

63
Q

What co-morbidities can increase the risk of wound haematoma post-Caesarean section?

A
  • Large BMI
  • Diabetes
  • Immunocompromised
64
Q

What are the potential immediate neonatal complications of Caesarean section?

A
  • Transient tachypnoea of newborn

- Fetal lacerations

65
Q

What is the risk of fetal laceration in Caesarean section?

A

1-2%

66
Q

What can make the risk of fetal laceration higher in Caesarean section?

A

Previous membrane rupture

67
Q

What are the potential intermediate complications of Caesarean section?

A
  • Infection

- Venous thrombosis

68
Q

What types of infection can result from Caesarean section?

A
  • UTI
  • Endometritis
  • Respiratory tract infection
69
Q

When is the risk of respiratory tract infection higher in Caesarean section?

A

When GA is used

70
Q

What are the potential larger complications of Caesarean section?

A
  • Urinary tract trauma (fistula)
  • Subfertility
  • Regret and other negative psychological sequelae
  • Rupture/dehiscence of scar next labour
  • Placenta praevia/accrete
  • C-section scar ectopic pregnancy

4: Y4 - Obstetrics [13] (61 decks)

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