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