Caesarean Section Flashcards
What is a c-section?
A surgical operation to deliver the baby via an incision in the abdomen and uterus
What are the two classifications of c-sections?
Elective
Emergency
What is an elective c-section?
A planned operation in which a woman will come in for delivery
At what gestation age is an elective c-section usually performed?
39 weeks gestation
What are the seven indications for an elective c-section?
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
What is placental praevia?
A condition when the placenta is low lying and reaches the internal os of the cervix
What is an emergency c-section?
An unplanned operation
When is an emergency c-section performed? What are the three specific indications?
When there are acute problems during the antenatal period or labour
Foetal distress
Failure to progress in labour
Failed induction of labour
Define category one c-sections. What is the delivery time they should be conducted within?
There is an immediate threat to the life of the mother or baby
30 minutes
Define category two c-sections. What is the delivery time they should be conducted within?
There is no imminent threat to life, but c-section is required urgently due to compromise of the mother or baby
60-75 minutes
Define category three c-sections
There is no maternal or fetal compromise but needs an early delivery
Define category four c-sections
This is an elective delivery
What anaesthesia is used during a c-section?
Regional anaesthetic
This is usually a topped-up epidural or a spinal anaesthetic
What is spinal anaesthetic?
It involves giving an injection of local anaesthetic into the cerebrospinal fluid at the lower back
This blocks the nerves from the abdomen downwards
What general type of incision is made during c-sections? What are the two specific incisions made?
A transverse lower uterine segment incision
Pfannenstiel Incision
Joel-Cohen Incision
What is a Pfannenstiel incision?
It is a curved incision two fingers width above the pubic symphysis
What is a Joel Cohen incision?
A straight incision that is made slightly above the Pfannenstiel incision
What is the recommended c-section incision?
Joel Cohen incision
What do we do after the initial incision during a c-section?
Blunt dissection to separate the remaining layers of the abdominal wall and uterus
What are the eight layers dissected during a c-section?
Skin
Camper’s Fascia
Scarpa’s Facia
Rectus Sheath
Rectus Abdominis Muscle
Abdominal Peritoneum
Vesicouterine Peritoneum
Uterus
What is Camper’s fascia?
The superficial fatty layer of the subcutaneous tissue
What is Scarpa’s fascia?
The deep membranous layer of the subcutaneous tissue
What is the rectus sheath?
The aponeuroses of the transversus abdominus, external oblique and internal oblique muscles
What is the vesicouterine peritoneum?
The vesicouterine peritoneum covers the lower segment of the uterus
What do we do after dissecting the vesicouterine peritoneum?
It is pushed down to reflect the bladder, which is then retracted by the Doyen retractor
How do we assist delivery of the baby during a c-section?
We apply pressure on the fundus of the uterus
In some cases, forceps are required
What has a higher risk of complication - elective or emergency c-sections? Why?
Emergency
They are usually performed in less controlled settings and for more acute indications
What are six the immediate complications of a c-section?
Postpartum Haemorrhage
Wound Haematoma
Intra-Abdominal Haemorrhage
Bladder/Bowel Trauma
Fetal Lacerations
Transient Tachypnoea of the Newborn
What are the three intermediate complications of a c-section?
Infection
Endometritis
Venous Thromboembolism
What are the four late complications of a c-section?
Subfertility
Placenta Praevia Risk
Uterine Rupture Risk
Stillbirth Risk
What are the five management methods used to prevent c-section complications?
H2 Receptor Antagonists
Prophylactic Antibiotics
Oxytocin
Low Molecular Weight Heparin
Foley’s Catheter
When do we prescribe H2 receptor antagonists for c-sections? What is their role?
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
What H2 receptor antagonist is prescribed for c-sections?
Ranitidine
When do we prescribe prophylactic antibodies for c-sections? What is their role?
During the procedure
To reduce the risk of infection
When do we prescribe oxytocin for c-sections? What is their role?
During the procedure
To reduce the risk of postpartum haemorrhage
When do we prescribe low molecular weight heparin for c-sections? What is their role?
During the procedure
To reduce the risk of venous thromboembolism
When do we insert a Foley’s catheter for c-sections? What is their role?
Before the procedure
To drain the bladder and to reduce the risk of bladder injury
