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
What catheter is inserted before C section?
Indwelling Foley’s catheter
26
What is the point of inserting an Indwelling Foley’s catheter before C section? (2 things)
1. To drain bladder 2. To reduce risk of bladder injury @ procedure
27
What should be administered just prior C section incision?
Abx
28
What is the C section incision?
Transverse lower abd skin incision
29
What layers have to be cut to get down to baby? (8 things) (IN ORDER)
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
What is the Camper’s fascia?
Superficial fatty layer of subcut tissue
31
What is the Scarpa’s fascia?
Deep membranous layer of subcut tissue
32
What does cutting the Abdominal peritoneum reveal?
Gravid uterus
33
What do you do once you reach Visceral Peritoneum (covering lower uterus)? (2 steps)
1. Cut it and push down to reflect bladder 2. Bladder then retracted by Doyen retractor
34
How is the placenta delivered in C section?
Controlled cord traction by surgeon
35
What should the anaesthetist give to aid with the placenta delivery?
Oxytocin 5 units
36
What complications of Vaginal delivery do C sections protect against? (6 things)
1. Perineal trauma 2. Pain 3. Urinary / faecal incontinence 4. Uterovaginal prolapse 5. Late stillbirth 6. Early neonatal infections
37
What are the complications of C sections classified into? (3 things)
1. Immediate 2. Intermediate 3. Late
38
What are the Immediate complications of C sections? (6 things)
1. PPH 2. Wound haematoma 3. Intra-abd haemorrhage 4. Bladder / bowel trauma 5. Transient Tachypnoea of Newborn (TTN) 6. Foetal lacerations
39
What are the Intermediate complications of C sections? (4 things)
1. UTI 2. Endometritis 3. Resp infection (higher risk if GA used) 4. VTE
40
What are the Late complications of C sections? (6 things)
1. Urinary tract trauma (fistula) 2. Infertility 3. Regret 4. Rupture / dehiscence of scar @ next labour 5. Placenta praevia 6. Caesarean scar ectopic preg