C-section

Question 1

What are the indications for a C-section?

Answer 1

Antepartum

Maternal:

• 2 prior C-sections
• pelvic anomaly
• prior shoulder dystocia
• medical conditions (e.g. cardiac)
• obstetric conditions (e.g. severe pre-eclampsia0

Fetal:

• fetal anomalies
• macrosomia
• malpresentation
• APH/abruption
• Twins
• abnormal placentation

Postpartum

Maternal:

• failure to progress
• unsuccessful intrumentation
• unsuccessful induction

Fetal:

• fetal distress
• cord prolapse
• uterine rupture

Question 2

Preparation for C-sections?

Answer 2

• review Hx/Ix
• consent
  
  • complications
  • difficult in emergency
• IV access, bloods (goruping and holds, coags, FBE).
• communication with OT/anaesthetics/paediatricians
• positioning of the patients
  
  • supine with left-lateral tilt (uterus off IVC)
• urinary bladder drainage (IDC) - drain bladder
• auscultate fetal heart and confirm presentation - ensure baby still alive.
• antibiotic prophylaxis

Question 3

What are some complications from C-sections?

Answer 3

• General:
  
  • anaesthetic complications
  • haemorrhage after
  • risk of blood transfusion
  • infection
  • DVT
  • damage to adjacent organs
  • death
• Obstetrics
  
  • hysterectomy
  • abnormal placentation in future pregnancies (+ correlations with # of C-sections).
  • scar rupture in future pregnancies
  • regret/psychological impact

Question 4

What postoperative care should you consider in a mother who has had a C-section?

Answer 4

• analgesia
• VTE prophylaxis
  
  • TEDS
  • heparin
• lactation suport
• mobilization
• IV fluids
• bladder care
  
  • normal voiding
  • IDC
• wound care

Question 5

What anaesthetics considerations might you think about for C-sections?

Answer 5

Regional > General - not always quicker, more control.

Spinal

• dense block
• predictable
• rapid onset
• inflexible - can’t top up

Epidural

• slower onset
• less predictable
• can be topped up and used post-op.
• already in situ pre-op

General

• highest risk
• used when regional anaesthetic contraindicated
• indicated when excessive blood loss anticipated.

Question 6

What is VBAC? What are some factors to consider in this instance?

Answer 6

Vaginal Birth after caesarian

• primary risk is uterine rupture.
• generally only safe if 1xLUTCS
• change of success depends on RFs and maternal age, obesity, etc..
• requirement of singleton cephalic fetus, monitoring, immediate OT access.
• no induction.