C Section

Question 1

What are the 2 classifications of C sections?

Answer 1

1. Elective
2. Emergency

Question 2

What is Emergency C sections further classified into?

Answer 2

Categories 1-3

Question 3

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

Answer 3

Baby should be born within 30 mins

(Bc immediate threat to life of mum / foetus)

Question 4

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

Answer 4

Baby should be born within 60-75 mins

(Mum / foetus but not immediately life threatening)

Question 5

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

Answer 5

Early delivery

(But no maternal / foetal compromise)

Question 6

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

Answer 6

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

Question 7

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

Answer 7

When Twin 1 not cephalic presentation

Question 8

What is Placenta Praevia?

Answer 8

Low lying placenta

Question 9

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

Answer 9

When placenta covers / reaches internal os of Cervix

Question 10

When are C sections usually planned for?

Answer 10

After 39 weeks

Question 11

Why are C sections usually planned for after 39 weeks?

Answer 11

To reduce Neonatal resp distress

Question 12

What is Neonatal resp distress aka?

Answer 12

Transient Tachypnoea of Newborn (TTN)

Question 13

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

Answer 13

Corticosteroids

Question 14

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

Answer 14

Stimulates dev of surfactant in Foetal lungs

Question 15

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

Answer 15

1. FBC
2. G&S
3. VTE risk score

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

What should be prescribed before C section?

Answer 18

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

Question 19

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

Answer 19

To protect against Mendelson’s syndrome

Question 20

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

Answer 20

1. Stockings
2. LMWH

Question 21

What anaesthesia are C sections usually done under?

Answer 21

Regional anaesthetic (epidural / spinal)

Question 22

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

Answer 22

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

Question 23

What position is the C section woman placed in?

Answer 23

Left Lateral tilt of 15°

Question 24

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

Answer 24

To reduce risk of supine hypotension due to Aortocaval compression

Question 25

What catheter is inserted before C section?

Answer 25

Indwelling Foley’s catheter

Question 26

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

Answer 26

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

Question 27

What should be administered just prior C section incision?

Answer 27

Abx

Question 28

What is the C section incision?

Answer 28

Transverse lower abd skin incision

Question 29

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

Answer 29

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

Question 30

What is the Camper’s fascia?

Answer 30

Superficial fatty layer of subcut tissue

Question 31

What is the Scarpa’s fascia?

Answer 31

Deep membranous layer of subcut tissue

Question 32

What does cutting the Abdominal peritoneum reveal?

Answer 32

Gravid uterus

Question 33

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

Answer 33

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

Question 34

How is the placenta delivered in C section?

Answer 34

Controlled cord traction by surgeon

Question 35

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

Answer 35

Oxytocin 5 units

Question 36

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

Answer 36

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

Question 37

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

Answer 37

1. Immediate 2. Intermediate 3. Late

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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