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#Phase 2.2: Obs n Gynae > C Section > Flashcards

C Section Flashcards

1
Q

What are the 2 classifications of C sections?

A
  1. Elective
  2. Emergency
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2
Q

What is Emergency C sections further classified into?

A

Categories 1-3

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3
Q

What does RCOG recommend when C Section Emergency Category 1 is called?

A

Baby should be born within 30 mins

(Bc immediate threat to life of mum / foetus)

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4
Q

What is usually recommended when C Section Emergency Category 2 is called?

A

Baby should be born within 60-75 mins

(Mum / foetus but not immediately life threatening)

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5
Q

What is usually recommended when C Section Emergency Category 3 is called?

A

Early delivery

(But no maternal / foetal compromise)

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6
Q

What are the indications for Elective C Sections? (11 things)

A
  1. Breech presentation
  2. Other malpresentation (e.g unstable / transverse / oblique lie)
  3. Twins (when Twin 1 not cephalic pres)
  4. Maternal conditions –> labour dangerous for mother
  5. Foetal compromise (e.g IUGR) –> labour dangerous for baby
  6. Transmissible disease (e.g HIV / herpes)
  7. Placenta praevia
  8. Maternal DM (w macrosomia)
  9. Previous Shoulder dystocia
  10. Previous Perineal tear
  11. Maternal request
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7
Q

When should Twins be considered to be delivered as a C section?

A

When Twin 1 not cephalic presentation

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8
Q

What is Placenta Praevia?

A

Low lying placenta

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9
Q

When should Placenta Praevia be considered to be delivered as a C section?

A

When placenta covers / reaches internal os of Cervix

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10
Q

When are C sections usually planned for?

A

After 39 weeks

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11
Q

Why are C sections usually planned for after 39 weeks?

A

To reduce Neonatal resp distress

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12
Q

What is Neonatal resp distress aka?

A

Transient Tachypnoea of Newborn (TTN)

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13
Q

When C sections should be planned for before 39 weeks, what should you give the mother?

A

Corticosteroids

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14
Q

What is the point of giving Corticosteroids when C sections are planned for before 39 weeks?

A

Stimulates dev of surfactant in Foetal lungs

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15
Q

What routine tests should be done before a C section? (3 things)

A
  1. FBC
  2. G&S
  3. VTE risk score
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16
Q

Why should FBC and G&S be taken before a C section?

A

Bc avg blood loss in C section is 500ml to 1L

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17
Q

What are women lying flat for C section at risk of? (2 points)

A
  1. Mendelson’s syndrome (aspiration of gastric contents)
  2. This leads to Chemical Pneumonitis
18
Q

What should be prescribed before C section?

A
  1. H2 receptor antagonist (e.g Ranitidine)
  2. +/- Metoclopramide (anti-emetic)
19
Q

What is the point of H2 receptor antagonist +/- Metoclopramide b4 C section?

A

To protect against Mendelson’s syndrome

20
Q

What should be prescribed before C section if VTE risk score is high? (2 things)

A
  1. Stockings
  2. LMWH
21
Q

What anaesthesia are C sections usually done under?

A

Regional anaesthetic (epidural / spinal)

22
Q

When is using General Anaesthesia indicated for C sections? (3 things)

A
  1. Category 1 Emergency C section (bc foetal wellbeing concerns)
  2. Maternal CI to regional
  3. Regional failing to achieve req block
23
Q

What position is the C section woman placed in?

A

Left Lateral tilt of 15°

24
Q

Why is the woman put into a Left Lateral tilt of 15° in C section?

A

To reduce risk of supine hypotension due to Aortocaval compression

25
Q

What catheter is inserted before C section?

A

Indwelling Foley’s catheter

26
Q

What is the point of inserting an Indwelling Foley’s catheter before C section? (2 things)

A
  1. To drain bladder
  2. To reduce risk of bladder injury @ procedure
27
Q

What should be administered just prior C section incision?

A

Abx

28
Q

What is the C section incision?

A

Transverse lower abd skin incision

29
Q

What layers have to be cut to get down to baby? (8 things) (IN ORDER)

A
  1. Skin
  2. Camper’s fascia
  3. Scarpa’s fascia
  4. Rectus sheath
  5. Rectus muscle
  6. Abd peritoneum (parietal)
  7. Visceral Peritoneum (covers lower uterus)
  8. Uterus
30
Q

What is the Camper’s fascia?

A

Superficial fatty layer of subcut tissue

31
Q

What is the Scarpa’s fascia?

A

Deep membranous layer of subcut tissue

32
Q

What does cutting the Abdominal peritoneum reveal?

A

Gravid uterus

33
Q

What do you do once you reach Visceral Peritoneum (covering lower uterus)? (2 steps)

A
  1. Cut it and push down to reflect bladder
  2. Bladder then retracted by Doyen retractor
34
Q

How is the placenta delivered in C section?

A

Controlled cord traction by surgeon

35
Q

What should the anaesthetist give to aid with the placenta delivery?

A

Oxytocin 5 units

36
Q

What complications of Vaginal delivery do C sections protect against? (6 things)

A
  1. Perineal trauma
  2. Pain
  3. Urinary / faecal incontinence
  4. Uterovaginal prolapse
  5. Late stillbirth
  6. Early neonatal infections
37
Q

What are the complications of C sections classified into? (3 things)

A
  1. Immediate
  2. Intermediate
  3. Late
38
Q

What are the Immediate complications of C sections? (5 things)

A
  1. PPH
  2. Wound haematoma
  3. Bladder / bowel trauma
  4. Transient Tachypnoea of Newborn (TTN)
  5. Foetal lacerations
39
Q

What are the Intermediate complications of C sections? (4 things)

A
  1. Resp infection (higher risk if GA used)
  2. Endometritis
  3. UTI
  4. VTE
40
Q

What are the Late complications of C sections? (6 things)

A
  1. Regret
  2. Urinary tract trauma (fistula)
  3. Infertility
  4. Caesarean scar ectopic preg
  5. Placenta praevia
  6. Rupture / dehiscence of scar @ next labour

#Phase 2.2: Obs n Gynae (27 decks)

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