Caesarean birth NICE

Question 1

What % deliveries are by CS

Answer 1

25-30%

Question 2

If previous CS and low placenta, when to offer USS

Answer 2

Offer colour flow doppler USS at 32-34 weeks.
If concern accreta, for MRI

Question 3

What factors reduce risk of CS in labour>

Answer 3

1 to 1 support
Partogram
Cons led decision making

Question 4

What factors do not influence risk of EMCS?

Answer 4

Walking in labour
Non supine position in 2nd stage
immersion in water
epidural
Raspberry leaves

Question 5

Definition Cat 1 EMCS

Answer 5

Delivery within 30 mins

Immediate threat to life
Uterine rupture, major abruption, cord prolapse, fetal hypoxia, persistent fetal bradycardia

Question 6

Definition Cat 2 EMCS

Answer 6

Delivery 75 mins
Maternal/fetal compromise not immediate threat to life

Question 7

Definition Cat 3

Answer 7

No maternal, fetal compromise but needs early birth

Question 8

Defintion Cat 4

Answer 8

Birth time to suit women

Question 9

What degree of tilt should be on operating table?

Answer 9

15 degree, minimise maternal hypotension

Question 10

What should be offered to women with spinal?

Answer 10

Prophylactic IV phenylephrine to keep BP 90%

Question 11

When using phenylephrine infusion, what can be given to treat hypotension?

Answer 11

intravenous ephedrine

Question 12

Fluids and blood products should be warmed to what temperature?

Answer 12

37

Question 13

What methods should be used to reduce the risk of infection

Answer 13

Clean chlorhexadine
aqueous iodine vaginal preparation if ROM

Question 14

What extra precaution if HIV +ve

Answer 14

Double glove

Question 15

How to incise well formed lower segment?

Answer 15

Blunt rather than sharp to reduce blood loss

Question 16

Risk fetal laceration

Answer 16

2%

Question 17

What uterotonic?

Answer 17

5units IV oxytocin

Question 18

Should routine exteriorisation be used?

Answer 18

No higher pain
No effect risk of bleeding infection

Question 19

Does closing in single layer effect risk of future uterine rupture?

Answer 19

No

Question 20

Do no close fat under which depth>

Answer 20

2cm

Question 21

What % of women experience wound infection, endometritis or UTI after CS

Answer 21

8%

Question 22

Following GA and regained airway control, is haemodynamically stable, and is able to communicate after caesarean birth under a general anaesthetic, how often should obs be done>

Answer 22

Every 30 mins for 2 hours
If stable after 2 hours, routine obs

Question 23

If intrathecal, epidural diamorphine for CS, how often should obs be done

Answer 23

1 hourly for 12 hours (O2 sats, RR, sedation)

morphine worse than diamprohone and may be need to monitored for longer

Question 24

What post op analgesia should be offered to women who have had GA CS

Answer 24

PCA

Question 25

Why should codeine or co-dydramol not be offered to women who are breastfeeding>

Answer 25

lead to serious neonatal sedation and respiratory depression

Dihydrocodiene does not

Question 26

When can the catheter be removed following CS>

Answer 26

Once mobile but no sooner than 12 hrs after last top up

Question 27

When should negative pressure dressing be considered?

Answer 27

BMI >35

Question 28

When should standard dressing be removed/replaced?

Answer 28

6 to 24 hours after