Caesarean section Flashcards
What is a c-section?
Delivery of a baby through a surgical incision in the abdomen or uterus
What are the two types of c-section?
Emergency or elective
What are the 3 categories of emergency c-section
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
Describe elective c-section
Delivery timed to suit woman or staff
When a category 1 section is called what is the maximum time the baby should be born in?
30 mins
When a category 2 is called what is the maximum time the baby should be born?
60-75mins
What is the most common reason for emergency c-section?
Failure to progress in labour or suspected/foetsl compromise
List some indications for elective c-section
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
When are elective c-sections planned and why?
After 39 weeks to reduce respiratory distress in the neonate (transient tachypnoea of the newborn)
What is give to those where c-section is performed before 39 weeks and why?
Corticosteroids - stimulates development of surfactant in the foetal lungs
Describe pre-operative care of c-section
FBC
G&S
H2 receptor antagonist - reduce risk of mendelsons syndrome
VTE risk score - anti-thrombolic stockings +/- LMWH
What is the average blood loss at c-section?
500-1000ml
Describe Mendelson’s syndrome
Aspiration of gastric contents leading to chemical pneumonitis - pressure applied by the gravid uterus on gastric contents
Describe the anaesthesia used in c-sections
Regional - topped up epidural or spinal anaesthetic
Sometimes GA is required
Why might general anaesthetic be required in C-section?
Maternal CI to regional
Failure of regional to achieve the required block
Concerns about foetal wellbeing and needing to expedite delivery asap (category1 section)
Describe the operative procedure of c-section
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
Why is woman laid in left lateral tilt?
Reduce risk of supine hypotension due to aortocaval compression
Why is a catheter placed prior to c-section/
Drain the bladder and reduce risk of bladder injury
Which incisions are used in c-section
Pfannenstiel or Joel-cohen - both transverse lower abdominal incisions
List the layers which are dissected in c-section
Skin Campers fascia Scarpa's fascia Rectus sheath Rectus muscle Abdominal peritoneum Reveals the gravid uterus
Describe post-operative care following c-section
Observations recorded on NEWS chart and lochia monitored
Early mobilisation, eating and drinking, removal of catheter
What is lochia?
Per vaginal blood loss post delivery
What does a primary caeserean section reduce the risk of?
Perineal trauma and pain, urinary and anal incontinence, uterovaginal prolapse, late stillbirth and early neonatal infections
List the immediate complications of c-section
PPH Wound haematoma Intra-abdominal haemorrhage Bladder/bowel trauma Neonatal - transient tachypnoea of newborn and foetal lacerations
List the intermediate complications of c-section
Infection - UTI, endometritis, respiratory
VTE
List the late complication of c-section
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
What category section is an elective?
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