C section Flashcards
1
Q
indications for C/S
A
maternal
- previous C/S: complicated, not lower segment section, risk factor for C/S is still present
- pre-eclampsia
- GDM with other indication
- infection
- severe deterioration
antenatal
- IUGR or macrosomia
- placenta praevia
- severe antenatal haemorrhage
- sepsis
- chorioamnionitis
labour
- malpresentation
- cord presentation or prolapse
- obstructed labour
- foetal distress
- infection
2
Q
signs of uterine rupture
A
severe suprapubic pain
vaginal bleeding
reduced LOC
foetal and maternal distress
3
Q
benefits and risks of VBAC
A
benefits
- quicker recovery and shorter hospital stay
- avoid risks associated with C/S
risks
- uterine rupture
- normal VB risks
- conversion to unplanned C/S (higher risks than planned)
- requires tertiary centre care
4
Q
benefits, risks and alternatives for C/S
A
benefits
- individualised to patient
- reduces intrapartum risks to baby
- simple and effective
- planned date
risks
- spinal: reaction to anaesthetic, headache, hypotension, infection, neuro damage, bleeding
- GA: reaction, DVT/PE, MI/stroke, atelectasis/pneumonia
- specific: longer recovery, infection, haemorrhage, damage to nearby structures (ureter, bladder, bowel), foetal laceration, adhesions, resp distress in newborn, risks for future pregnancies
alternatives - vaginal delivery
- risks: tear, foetal risks (eg obstruction)
- benefits: avoid C/S risks, quicker recovery
5
Q
counselling for C/S
- before, during and after
A
before
- NBM, bloods
- spinal: needle into spine, pain free chest down
- epidural: if already in situ
- GA: for emergency, put to sleep
during
- cut just above pubic hair line
- cut into uterus
- retrieve baby
- check baby is ok
- skin to skin with mother
- close wound with stitches
after
- immediate: recovery, encourage breast feed, stay in hospital 3 days, anticoagulation, analgesia
- long term: 4-6 weeks to recover, rest, keep wound covered and clean
- practical: no heavy lifting, no sex, no driving, encourage to mobilise early, F/U with GP
