Caesarean Section

Question 1

What is a c-section?

Answer 1

A surgical operation to deliver the baby via an incision in the abdomen and uterus

Question 2

What are the two classifications of c-sections?

Answer 2

Elective

Emergency

Question 3

What is an elective c-section?

Answer 3

A planned operation in which a woman will come in for delivery

Question 4

At what gestation age is an elective c-section usually performed?

Answer 4

39 weeks gestation

Question 5

What are the seven indications for an elective c-section?

Answer 5

Breech Presentation

Twin Pregnancy, in which the first twin is not cephalic

Placenta Praevia

Pre-Eclampsia

Previous C-Section

Perineal Tear, which is graded three or four and symptomatic

Uncontrolled HIV Infection

Question 6

What is placental praevia?

Answer 6

A condition when the placenta is low lying and reaches the internal os of the cervix

Question 7

What is an emergency c-section?

Answer 7

An unplanned operation

Question 8

When is an emergency c-section performed? What are the three specific indications?

Answer 8

When there are acute problems during the antenatal period or labour

Foetal distress

Failure to progress in labour

Failed induction of labour

Question 9

Define category one c-sections. What is the delivery time they should be conducted within?

Answer 9

There is an immediate threat to the life of the mother or baby

30 minutes

Question 10

Define category two c-sections. What is the delivery time they should be conducted within?

Answer 10

There is no imminent threat to life, but c-section is required urgently due to compromise of the mother or baby

60-75 minutes

Question 11

Define category three c-sections

Answer 11

There is no maternal or fetal compromise but needs an early delivery

Question 12

Define category four c-sections

Answer 12

This is an elective delivery

Question 13

What anaesthesia is used during a c-section?

Answer 13

Regional anaesthetic

This is usually a topped-up epidural or a spinal anaesthetic

Question 14

What is spinal anaesthetic?

Answer 14

It involves giving an injection of local anaesthetic into the cerebrospinal fluid at the lower back

This blocks the nerves from the abdomen downwards

Question 15

What general type of incision is made during c-sections? What are the two specific incisions made?

Answer 15

A transverse lower uterine segment incision

Pfannenstiel Incision

Joel-Cohen Incision

Question 16

What is a Pfannenstiel incision?

Answer 16

It is a curved incision two fingers width above the pubic symphysis

Question 17

What is a Joel Cohen incision?

Answer 17

A straight incision that is made slightly above the Pfannenstiel incision

Question 18

What is the recommended c-section incision?

Answer 18

Joel Cohen incision

Question 19

What do we do after the initial incision during a c-section?

Answer 19

Blunt dissection to separate the remaining layers of the abdominal wall and uterus

Question 20

What are the eight layers dissected during a c-section?

Answer 20

Skin

Camper’s Fascia

Scarpa’s Facia

Rectus Sheath

Rectus Abdominis Muscle

Abdominal Peritoneum

Vesicouterine Peritoneum

Uterus

Question 21

What is Camper’s fascia?

Answer 21

The superficial fatty layer of the subcutaneous tissue

Question 22

What is Scarpa’s fascia?

Answer 22

The deep membranous layer of the subcutaneous tissue

Question 23

What is the rectus sheath?

Answer 23

The aponeuroses of the transversus abdominus, external oblique and internal oblique muscles

Question 24

What is the vesicouterine peritoneum?

Answer 24

The vesicouterine peritoneum covers the lower segment of the uterus

Question 25

What do we do after dissecting the vesicouterine peritoneum?

Answer 25

It is pushed down to reflect the bladder, which is then retracted by the Doyen retractor

Question 26

How do we assist delivery of the baby during a c-section?

Answer 26

We apply pressure on the fundus of the uterus

In some cases, forceps are required

Question 27

What has a higher risk of complication - elective or emergency c-sections? Why?

Answer 27

Emergency

They are usually performed in less controlled settings and for more acute indications

Question 28

What are six the immediate complications of a c-section?

Answer 28

Postpartum Haemorrhage

Wound Haematoma

Intra-Abdominal Haemorrhage

Bladder/Bowel Trauma

Fetal Lacerations

Transient Tachypnoea of the Newborn

Question 29

What are the three intermediate complications of a c-section?

Answer 29

Infection

Endometritis

Venous Thromboembolism

Question 30

What are the four late complications of a c-section?

Answer 30

Subfertility

Placenta Praevia Risk

Uterine Rupture Risk

Stillbirth Risk

Question 31

What are the five management methods used to prevent c-section complications?

Answer 31

H2 Receptor Antagonists

Prophylactic Antibiotics

Oxytocin

Low Molecular Weight Heparin

Foley’s Catheter

Question 32

When do we prescribe H2 receptor antagonists for c-sections? What is their role?

Answer 32

Before the c-section

This is to prevent the risk of aspiration pneumonitis, caused by acid reflux and aspiration during the prolonged procedure lying flat

Question 33

What H2 receptor antagonist is prescribed for c-sections?

Answer 33

Ranitidine

Question 34

When do we prescribe prophylactic antibodies for c-sections? What is their role?

Answer 34

During the procedure

To reduce the risk of infection

Question 35

When do we prescribe oxytocin for c-sections? What is their role?

Answer 35

During the procedure

To reduce the risk of postpartum haemorrhage

Question 36

When do we prescribe low molecular weight heparin for c-sections? What is their role?

Answer 36

During the procedure

To reduce the risk of venous thromboembolism

Question 37

When do we insert a Foley’s catheter for c-sections? What is their role?

Answer 37

Before the procedure

To drain the bladder and to reduce the risk of bladder injury