C-section Flashcards
What are the risks of elective repeat Caesarian sections?
Morbidly Adherent placenta
Injury to bladder and bowel
Increased risk of hysterectomy
What are signs of uterine rupture
Abnormal pain between contractions Fetal distress Diminished or altered uterine activity Alterations in fetal movement Haematuria
Ctg may be the earliest sign of a rupture
What are the factors associated with a successful VBAC?
Previous VBAC
Birth interval >2 years
Spontaneous labour
Estimated fetal weight
What are the indications for a c section?
Maternal
- placenta Praevia (major)
- previous classical c section
- previous uterine surgery
- cervical carcinoma
- serious medical conditions
- bearing down efforts contraindicated ( cerebral aneurysm)
- uterine rupture
- previous vaginal repair or surgery for urinary incontinence
Fetal
- fetal distress
- prolapsed cord and live baby
- abruptio with live baby
- transverse lie
- brow or mento- posterior face presentation
- breech presentation
- multiple pregnancy
- macrosomia
- some congenital abnormalities
Combined:
- failure to progress
- failed forceps or vacuum
- failed induction of labour
What are the types of Caesarian section?
Transverse lower uterine segment
Vertical lower uterine segment
Vertical upper uterine segment
What are the indications for a classical c section
- absent or underdeveloped lower uterine segment
- inaccessible lower uterine segment (eg adherent bowel)
- transverse lie
- anterior placenta Praevia
- carcinoma cervix
- fibroids occupying the lower segment
- post Mortem c section
What are the anaesthetic complications of a c section
High spinal
Failed intubation
Aspiration (particularly in pregnancy with delayed stomach emptying)
Atelectasis
What are the surgical complications or pregnancy?
Haemorrhage
Trauma: bowel, bladder, ureter
Sepsis: endometritis, wound
Thromboembolism
Contra indications to a VBAC
- previous classical c/ section
- 2 or more previous c sections
- patient refusal
- large baby
- malpresentation or other complication
- multiple pregnancy
- placenta Praevia
When is an elective repeat Caesarian scheduled for?
38-39 weeks gestation
What can be done if bleeding is uncontrolled during c-section?
- rub up uterus
- oxytocin infusion + 0.2mg Im ergometrine. Drugs can be given together.
- transfuse as necessary
- have assitant press over aorta untill cause found
- bleeding does stop? Perform uterine and uterine ivary artery ligation or hystorectomy
What happens if baby is breech during c-section?
- grasp foot and deliver via incision
- complete delivery as vaginal breech(deliver legs body and arms and flex head using mauriceau smellie)
What happens if baby is transverse?
If babys back is up(near top of uterus) - grasp ankles and pull through incision
If babys back is down?
High vertical uterine incision is needed, find feet and pull through incision.
What are some post op care principles?
If bleeding ?
- massage uterus
- give oxy and ergo
If signs of infection and woman has a fever give anti bio until fever free for 48hrs
- ampicill 2g iv every 6hrs
- gentamicin 5mg/kg iv every 24hrs
- metronidazole 500mg iv every 8hrs
