C-section Flashcards
What is a c-section
Birth of an infant through a transabdominal and uterine incisoin
Reasons why c -sections are becoming more popular?
Fear of uterine rupture w VBAC Avoid pain from vaginal birth Avoid trauma to pelvic floor Ability to schedule birth Nulliparous women requesting CS after 39 weeks
Actual indications to do csection?
Any major reason to not to the vaginal birth really
Complete placenta previa
Active genital herpes
HIV + with high viral load
Hypertensive rate making patient unable to be induced
Repeat CS
OR emergencies
fetal distress, placenta abruptio, uterine rupture
Does vaginal birth or c section have higher mortality?
Which is usually more expensive?
C section 3.6x more
The c section bc you will stay longer in hospital
Morbidity or disease risks of c section in general?
Increased risk in in subsequent PG?
Increase of infections, anesthesia risks, clots, bleeding, hypertensive disorders
Subsequent pg : uterine rupture, hemorrhage, previa, abruption, fetal demise, & neo RDS
Main skin incision
Transverse or pfannenstiel - a bikini incision
List of uterine incisions
Low transverse or kerr
Low vertical
Classic
Why use the low transverse uterine incision?
blood loss
bladder
repair
subequent PG
You lose less blood bc of less skin
There’s moderate deflection of the bladder
Easier to repair but takes longer
Less rupture risk with subsequent PG
Why wouldn’t you want to use low transverse?
How long
Size of baby
Extend
Stretch
Making the incision takes longer
Not good for large babies
Can extend into lateral blood vessels
Incision can stretch and become thin
Why use low vertical uterine incision
Good for multiple gestations Good for abnormal fetal presentations Placenta previa is ok Non-reassuring fetal status option Preterm infants LGA infants
Why wouldn’t you lost low vertical uterine incisions
Due to incision extending into cervix Can take time to get past bladder Hemostasis and closure is more difficult Higher risk of rupture in PG And if you get this once, you'll have to get it again in all PG even if you technically could've done vaginal
What is the classic uterine incision
incision in the upper portion of uterus
- we don’t use it much anymore due to blood loss and difficulty of repair
- can rupture in next pgs
- repeat CS require
- NO TOLAC
What is TOLAC?
what reduces success?
Trial of labor or being given the opportunity to deliver vaginally after already having a csection
- only offered w low transverse
obesity
Greatest risk of TOLAC?
other risks?
Uterine rupture so don’t use cervical ripening agents
iterine dehiscence
hysterectomy w tear needed
infections
death
Advantages of TOLAC
fewer infections
less blood loss
fewer transfusions
shorter hospital stay
VBAC
vaginal birth after c section
Scheduled anesthesia for c sections
spinal
Emergent anesthesia for c sections
Combined
General anesthesia
Preoperative care needing to be done before the c section?
How do they do this?
Validate the fetus maturity is 39 weeks
With a sonogram or amniocentesis to get L/S. PG levels
What needs to be taken on admission for c section
All vitals including the baby’s FHR
Urinalysis. CBC, H&H
Blood and cross type
Accucheck glucose
What does NPO status need to be?
8 hours or more
Who is responsible for informed consent?
Doc but you are there to witness
Why do we remove nail polish?
for 02 sat
What things do we need to remove before c section?
What needs to be put on the patient?
Dentures
Orthodontic devices
Contacts (you can wear glasses if you want)
Put the proper hospital ID on and have the baby’s ID ready
Examples of anticipatory guidance you can give before procedure of c section
Deep breathing
Coughing
Turning
Leg exercises such as ankle rolls or leg lifts
What type of needle do IV fluids need to be started with ?
large bore needle but do it in the non-dominant hand
What do you do if the patient has any allergies before going into c section?
Clearly label it on the band they’re wearing
Notify anesthesia
Meds that might be used to neutralize gastric activity?
Antacids like Bicitra, Alka seltzer Gold
Drugs that decrease gastric secretions
Tagement or zantac
Drug that increases gastric emptying
Reglan
Why might we give antibiotics? Which route?
Given IV to prevent infection
How will we transport the patient if schedule c section?
What if it is emergent?
Walking
On bed
What needs to be used to drain the bladder before surgery?
Indwelling catheter that is placed after the block
- make sure to verify it drains by putting it below the bladder
Can mom have a support person in the OR for c section if she is awake?
What do they wear?
Yes she can. They sit at the head of the bed
They need to wear gown and shoe covers
How should the skin be prepped for c section? What do you do before this though?
Scrubbed and shaved
- make sure to rule out any allergies to iodine or prep
What type of anesthesia is given in c sections
regional spinal
How do they prevent vena cava syndrome and maternal hypotension during a c section?
Safety precautions for mom when it comes to the bed?
Tilt hips with wedge or table to 15 degrees from midline
Mom will be strapped down
What is it called when they give the time for when the procedure begins
Time out
When do they take the fetal monitoring systems off?
Will take FHR monitor off until right up to procedure
- internal and external
What needs to be turned on to prevent heat loss once baby is born
bed warmer
IV made that is always given after delivery of placenta
IV oxytocin to help uterus contract
How long will mom be in a recovery room if she is stable?
2 hours
Greatest concern for during recovery/postpartum
How to you check on this
Hemorrhage
Check funds, incision dressing , and lochia
What do you need to do in post op about the foley
Just watch it. Take strict I & O and note the coloring
When can mom do feeding
Once in recovery room if everyone is ok
capnography
measures CO2
- done in obese individuals a lot
- if they have this, they will remain down in the recovery room
When can mom do skin to skin
Can do it in recovery room
What is put on mom post op to prevent clots
SCD’s
- but if mom is already ambulating, she doesn’t need them. take them off bc they are $$
When can you transfer mom from her recovery room to the postpartum end?
What should you encourage as soon as mom is able to feel her legs?
When she is alert and orientated and feels her legs
Ambulation!
- it reduces clots & gas
What does mom need to completely avoid in recovery/post partum end? Why?
Avoid rocking, ice, straws, cold beverages, and carbonated beverages
- to reduce gas
What orders should you check before giving pain meds post partum?
Duramorph anesthesia PCA pump placement
What will fundal checks feel like once anesthesia wears off
very very painful
How long is the incision dressing left on?
24 hrs
Standards needed before taking out an IV in post partum recovery
Vs stable and mom is drinking fluids
No n/v
No iv meds anymore
No temp
If mom is having constipation post partum, what might be the cause
pain medications.
- offer stool softeners and aids
Before mom can begin ambulating, what do you need to assess for
Assess how steady mom is and if she gets dizzy or anything
- check BP
Common meds given before dismissal
Rh immune globulin
Rubella
Tetanus update
Influenza
Can mom drive while on pain meds
no
What is the heaviest thing mom can lift after c sectionbirth
Nothing heavier than the baby
VERY important dismissal education that you need to talk about w mom
Neonate Jaundice
Percent of weight loss
If they stooled or not
Feeding patterns
What do we need to screen mom for after delivery
post partum depression
When does mom need to call doctor if she’s having probelms
Temp of 100.4 and higher Urinary complaints Lochia regression Incision redness and drainage Abdominal pain
