Caesarean birth NICE Flashcards
What % deliveries are by CS
25-30%
If previous CS and low placenta, when to offer USS
Offer colour flow doppler USS at 32-34 weeks.
If concern accreta, for MRI
What factors reduce risk of CS in labour>
1 to 1 support
Partogram
Cons led decision making
What factors do not influence risk of EMCS?
Walking in labour
Non supine position in 2nd stage
immersion in water
epidural
Raspberry leaves
Definition Cat 1 EMCS
Delivery within 30 mins
Immediate threat to life
Uterine rupture, major abruption, cord prolapse, fetal hypoxia, persistent fetal bradycardia
Definition Cat 2 EMCS
Delivery 75 mins
Maternal/fetal compromise not immediate threat to life
Definition Cat 3
No maternal, fetal compromise but needs early birth
Defintion Cat 4
Birth time to suit women
What degree of tilt should be on operating table?
15 degree, minimise maternal hypotension
What should be offered to women with spinal?
Prophylactic IV phenylephrine to keep BP 90%
When using phenylephrine infusion, what can be given to treat hypotension?
intravenous ephedrine
Fluids and blood products should be warmed to what temperature?
37
What methods should be used to reduce the risk of infection
Clean chlorhexadine
aqueous iodine vaginal preparation if ROM
What extra precaution if HIV +ve
Double glove
How to incise well formed lower segment?
Blunt rather than sharp to reduce blood loss
Risk fetal laceration
2%
What uterotonic?
5units IV oxytocin
Should routine exteriorisation be used?
No higher pain
No effect risk of bleeding infection
Does closing in single layer effect risk of future uterine rupture?
No
Do no close fat under which depth>
2cm
What % of women experience wound infection, endometritis or UTI after CS
8%
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>
Every 30 mins for 2 hours
If stable after 2 hours, routine obs
If intrathecal, epidural diamorphine for CS, how often should obs be done
1 hourly for 12 hours (O2 sats, RR, sedation)
morphine worse than diamprohone and may be need to monitored for longer
What post op analgesia should be offered to women who have had GA CS
PCA
Why should codeine or co-dydramol not be offered to women who are breastfeeding>
lead to serious neonatal sedation and respiratory depression
Dihydrocodiene does not
When can the catheter be removed following CS>
Once mobile but no sooner than 12 hrs after last top up
When should negative pressure dressing be considered?
BMI >35
When should standard dressing be removed/replaced?
6 to 24 hours after
