C-section Flashcards
What is a caesarean section?
- surgical operation to deliver the baby via an incision in the abdomen and uterus
- can be planned (elective caesarean) or an emergency
WHat is an elective caesarean and when is it usually performed?
- planned date for a c-section usually performed under spinal anaesthetic
- usually planned after 39 weeks gestation
What are indications for an elective caesarean?
- prev c section
- prev symptomatic perineal tear
- placenta praevia
- vasa praevia
- breech presentation
- multiple pregnancy
- uncontrolled HIV infection
- cervical cancer
What are the four categories of an emergency c-section?
- cat 1: immediate threat to life of mother or baby -> done within 30 mins
- cat 2: compromise to mother or baby but not imminent threat to life -> done within 75 mins
- cat 3: c-section required but mother and baby stable
- cat 4: elective c section
What is the most commonly used skin incision in c sections?
-transverse lower uterine segment incision with scalpel
What are the possible tranverse incisions in c sections?
- pfannenstiel incision - curved and 2 fingers width above pubic symphysis
- joel-cohen incision - straight incision that is slighlty higher (recommended)
When might a vertical incision be used?
- rarely used
- may be used in very premature deliveries and anterior placenta praevia
What is used after the initial incision?
- blunt dissection is used after to separate the remaining layers of the abdominal wall and uterus
- involves using fingers, blunt instruments, and traction to tear the tissues apart, rarther than cut them with sharp tools like a scalpel
- this results in less bleeding and less risk of injury to baby
What are the layers of the abdomen that are dissected in a c-section
- skin
- subcut tissue
- fasia/rectus sheath
- rectus abdominal muscles (seperated vertically)
- peritoneum
- vesicouterine peritoneum (and bladder separated from uterus with bladder flap)
- uterus
- amniotic sac
How is the baby delivered after the cuts are made?
-delivered by hand with help from pressure on the fundus (forceps may be used if necessary)
How is are the cuts then closed after delivery?
- uterus closed using two layers of sutures
- exteriorisation (removing uterus) is avoided if possible
- abdomen and skin are then sutured and closed
What anesthetic is used during a c-section?
- spinal anesthetic such as lidocaine is most commoly used as it is safer and has a faster recovery then general
- though with spinal the patient remains awake and some pts might not tolerate this well and prefer to be asleep so general will be used
- spinal also takes longer to initiate then general
What are the risks associated with anaesthetic use in c-section?
- Allergic reactions or anaphylaxis
- Hypotension
- Headache
- Urinary retention
- Nerve damage (spinal anaesthetic)
- Haematoma (spinal anaesthetic)
- Sore throat (general anaesthetic)
- Damage to the teeth or mouth (general anaesthetic)
Why do emergency c-sections have higher risks for complications than electives?
-usually performed in less controlled settings and for more acute indications (fetal distress)
What are the possible complications of c-sections?
- general surgical risks: bleeding,infection, pain, VTE
- postpartum complications: PPH, wound infection/dehiscence, endometritis
- damage to local structures; ureter, bladder, bowel, blood vessels
- ileus/adhesions/hernias
