C Section Flashcards
What are the 2 classifications of C sections?
- Elective
- Emergency
What is Emergency C sections further classified into?
Categories 1-3
What does RCOG recommend when C Section Emergency Category 1 is called?
Baby should be born within 30 mins
(Bc immediate threat to life of mum / foetus)
What is usually recommended when C Section Emergency Category 2 is called?
Baby should be born within 60-75 mins
(Mum / foetus but not immediately life threatening)
What is usually recommended when C Section Emergency Category 3 is called?
Early delivery
(But no maternal / foetal compromise)
What are the indications for Elective C Sections? (11 things)
- Breech presentation
- Other malpresentation (e.g unstable / transverse / oblique lie)
- Twins (when Twin 1 not cephalic pres)
- Maternal conditions –> labour dangerous for mother
- Foetal compromise (e.g IUGR) –> labour dangerous for baby
- Transmissible disease (e.g HIV / herpes)
- Placenta praevia
- Maternal DM (w macrosomia)
- Previous Shoulder dystocia
- Previous Perineal tear
- Maternal request
When should Twins be considered to be delivered as a C section?
When Twin 1 not cephalic presentation
What is Placenta Praevia?
Low lying placenta
When should Placenta Praevia be considered to be delivered as a C section?
When placenta covers / reaches internal os of Cervix
When are C sections usually planned for?
After 39 weeks
Why are C sections usually planned for after 39 weeks?
To reduce Neonatal resp distress
What is Neonatal resp distress aka?
Transient Tachypnoea of Newborn (TTN)
When C sections should be planned for before 39 weeks, what should you give the mother?
Corticosteroids
What is the point of giving Corticosteroids when C sections are planned for before 39 weeks?
Stimulates dev of surfactant in Foetal lungs
What routine tests should be done before a C section? (3 things)
- FBC
- G&S
- VTE risk score
Why should FBC and G&S be taken before a C section?
Bc avg blood loss in C section is 500ml to 1L
What are women lying flat for C section at risk of? (2 points)
- Mendelson’s syndrome (aspiration of gastric contents)
- This leads to Chemical Pneumonitis
What should be prescribed before C section?
- H2 receptor antagonist (e.g Ranitidine)
- +/- Metoclopramide (anti-emetic)
What is the point of H2 receptor antagonist +/- Metoclopramide b4 C section?
To protect against Mendelson’s syndrome
What should be prescribed before C section if VTE risk score is high? (2 things)
- Stockings
- LMWH
What anaesthesia are C sections usually done under?
Regional anaesthetic (epidural / spinal)
When is using General Anaesthesia indicated for C sections? (3 things)
- Category 1 Emergency C section (bc foetal wellbeing concerns)
- Maternal CI to regional
- Regional failing to achieve req block
What position is the C section woman placed in?
Left Lateral tilt of 15°
Why is the woman put into a Left Lateral tilt of 15° in C section?
To reduce risk of supine hypotension due to Aortocaval compression