C-section

Question 1

What is an emergency c-section?

Answer 1

• Usually performed in labour- may also occur with acute antepartum problems – eg. placental abprution
• Prolonged 1st stage-diagnosed when full dilation is not imminent by 12-16hrs or earlier if labour was initially rapid
occasionally full dilation is achieved, but not all the criteria for instrumental delivery are met
most commonly, it is due to abnormalities of the ‘powers’ – eg. insufficient uterine action the ‘passenger’ or
‘passage’ may also contribute
Foetal distress

Question 2

What is an elective c-section?

Answer 2

• Performed to avoid labour- normally at 39 weeks as this reduces the risk of transient tachypnoea of the newborn from 6% (38 weeks) to 4%, if earlier, administration of steroids should be considered

Question 3

What are the absolute indications for c-section?

Answer 3

o	Placenta praevia
o	Severe antenatal foetal compromise
o	Uncorrectable abnormal lie
o	Previous vertical C-section
o	Gross pelvic deformity

Question 4

What are the relative indications for c-section?

Answer 4

o	Breech presentation
o	Severe IUGR
o	Twin pregnancy
o	Certain medical disorders
o	Previous C-section
o	Older nulliparous patients
•	When delivery is needed before 34 weeks, it is usual to perform C-section rather than induce labour
most common indications are severe pre-eclampsia and severe IUGR

Question 5

What are the maternal complications of C-section?

Answer 5

o Haemorrhage
o Need for blood transfusion
o Infection of the uterus or wound
o Rare visceral causes  eg. bladder or bowel damage
o Post-operative pain & immobility
o Venous thromboembolism
• Preoperative prophylactic antibiotics reduce the incidence of infection and thromboprophylactic measures are routine- approx 1 in 5000 women will die after C-section

Question 6

What are the foetal complications of c-section?

Answer 6

• An elective procedure increases the risk of foetal respiratory morbidity at any given gestation, in uncomplicated pregnancy it is not recommended before 39 weeks
• Foetal lacerations are rare and usually minor
• Bonding and breastfeeding are particularly affected by emergency procedures

Question 7

What are the consequences for subsequent pregnancies after c-section?

Answer 7

• The incidence of placenta praevia is more common in prengnancies after a C-section
• The placenta may implant more deeply than normal in the myometrium (accreta) or through into surrounding structures (percreta)