Caesarean section

Question 1

What is a c-section?

Answer 1

Delivery of a baby through a surgical incision in the abdomen or uterus

Question 2

What are the two types of c-section?

Answer 2

Emergency or elective

Question 3

What are the 3 categories of emergency c-section

Answer 3

1 - immediate threat to life of woman or foetus
2 - maternal or foetal comprise that is not immediately life threatening
3 - No maternal or foetal compromise but needs early delivery

Question 4

Describe elective c-section

Answer 4

Delivery timed to suit woman or staff

Question 5

When a category 1 section is called what is the maximum time the baby should be born in?

Answer 5

30 mins

Question 6

When a category 2 is called what is the maximum time the baby should be born?

Answer 6

60-75mins

Question 7

What is the most common reason for emergency c-section?

Answer 7

Failure to progress in labour or suspected/foetsl compromise

Question 8

List some indications for elective c-section

Answer 8

Breech presentation/malpresentation 
Twin pregnancy when first twin not cephalic 
Maternal medical conditions
Foetal compromise - IUGR/abnormal dopplers 
Transmissible disease - HIV
Primary genital herpes in 3rd trimester 
Placenta praevia 
Maternal diabetes
Previous 3rd/4th perineal tear 
Previous major shoulder dystocia
Maternal request

Question 9

When are elective c-sections planned and why?

Answer 9

After 39 weeks to reduce respiratory distress in the neonate (transient tachypnoea of the newborn)

Question 10

What is give to those where c-section is performed before 39 weeks and why?

Answer 10

Corticosteroids - stimulates development of surfactant in the foetal lungs

Question 11

Describe pre-operative care of c-section

Answer 11

FBC
G&S
H2 receptor antagonist - reduce risk of mendelsons syndrome
VTE risk score - anti-thrombolic stockings +/- LMWH

Question 12

What is the average blood loss at c-section?

Answer 12

500-1000ml

Question 13

Describe Mendelson’s syndrome

Answer 13

Aspiration of gastric contents leading to chemical pneumonitis - pressure applied by the gravid uterus on gastric contents

Question 14

Describe the anaesthesia used in c-sections

Answer 14

Regional - topped up epidural or spinal anaesthetic

Sometimes GA is required

Question 15

Why might general anaesthetic be required in C-section?

Answer 15

Maternal CI to regional
Failure of regional to achieve the required block
Concerns about foetal wellbeing and needing to expedite delivery asap (category1 section)

Question 16

Describe the operative procedure of c-section

Answer 16

Left lateral tilt of 15 degrees

Foleys catheter inserted when anaesthetic is ready

Skin cleaned with antiseptic solution and Abx administed prior to the knife to skin incision

Skin incision

Blunt/sharp dissection into abdomen through several layers

Visceral peritoneum icised and pushed down to reflect bladder which is retracted by the doyen retractor

Uterine incision is made on lower uterine segment beneath line of peritoneal reflection - transverse curvilinea incision which is digitally extended

Baby delivered cephalic/breech with fundal pressure from assistant

Oxytocin 5iu given IV by anaesthetist to aid delivery of placenta by controlled cord traction by the surgeon

Uterine cavity emptied and closed with two layers. Rectus sheath closed and then the skin - continuous/interrupted sutures or staples

Question 17

Why is woman laid in left lateral tilt?

Answer 17

Reduce risk of supine hypotension due to aortocaval compression

Question 18

Why is a catheter placed prior to c-section/

Answer 18

Drain the bladder and reduce risk of bladder injury

Question 19

Which incisions are used in c-section

Answer 19

Pfannenstiel or Joel-cohen - both transverse lower abdominal incisions

Question 20

List the layers which are dissected in c-section

Answer 20

Skin
Campers fascia
Scarpa's fascia 
Rectus sheath
Rectus muscle
Abdominal peritoneum 
Reveals the gravid uterus

Question 21

Describe post-operative care following c-section

Answer 21

Observations recorded on NEWS chart and lochia monitored

Early mobilisation, eating and drinking, removal of catheter

Question 22

What is lochia?

Answer 22

Per vaginal blood loss post delivery

Question 23

What does a primary caeserean section reduce the risk of?

Answer 23

Perineal trauma and pain, urinary and anal incontinence, uterovaginal prolapse, late stillbirth and early neonatal infections

Question 24

List the immediate complications of c-section

Answer 24

PPH
Wound haematoma 
Intra-abdominal haemorrhage
Bladder/bowel trauma
Neonatal - transient tachypnoea of newborn and foetal lacerations

Question 25

List the intermediate complications of c-section

Answer 25

Infection - UTI, endometritis, respiratory

VTE

Question 26

List the late complication of c-section

Answer 26

Urinary tract trauma - fistula
Subfertility - delay in conceiving
Regret and psychological sequale
Rupture/ dehiscence of scar at next labour
Placenta praevia/accrete
C-section scar ectopic pregnancy

Question 27

What category section is an elective?

Answer 27

4