Caesarean Section Flashcards
Indications for an elective Caesarean section
Previous caesarean
Symptomatic after a previous significant perineal tear
Placenta praevia
Vasa praevia
Breech presentation
Multiple pregnancy
Uncontrolled HIV infection
Cervical cancer
Categories of emergency Caesarean section
Category 1: Immediate threat to the life of the mother or baby. Decision to delivery time is 30 minutes.
Category 2: No imminent threat to life, but caesarean is required urgently due to compromise of the mother or baby. Decision to delivery time is 75 minutes.
Category 3: Delivery is required, but mother and baby are stable
Category 4: Elective caesarean
Types of incision
Pfannenstiel incision - curved incision two fingers width above the pubic symphysis
Joel-cohen incision - straight incision that is slightly higher (this is the recommended incision)
Layers of the abdomen that need to be dissected during a caesarean
Skin
Subcutaneous tissue
Fascia / rectus sheath (the aponeurosis of the transversus abdominis and external and internal oblique muscles)
Rectus abdominis muscles
Peritoneum
Vesicouterine peritoneum
Uterus (perimetrium, myometrium and endometrium)
Amniotic sac
Which anaesthetic is used in a Caesarean section
Spinal anaesthetic
Risks with spinal anaesthetic
Allergic reactions or anaphylaxis
Hypotension
Headache
Urinary retention
Nerve damage
Haematoma
Complications of a Caesarean section
Emergency caesarean riskier than elective caesarean
Aspirations pneumonitis
General:
- Bleeding
- Infection
- Pain
- VTE
Postpartum:
- Postpartum haemorrhage
- Wound infection
- Wound dehiscence
- Endometritis
Damage to local structures:
- Ureter
- Bladder
- Bowel
- Blood vessels
Effects on the abdominal organs:
- Ileus
- Adhesions
- Hernias
Effects of caesareans on future pregnancies
Increased risk of repeat caesarean
Increased risk of uterine rupture
Increased risk of placenta praevia
Increased risk of stillbirth
Risk of caesarean on the baby
Risk of lacerations (about 2%)
Increased incidence of transient tachypnoea of the newborn
Vaginal Birth After Caesarean contraindications
Previous uterine rupture
Classical caesarean scar (a vertical incision)
Other usual contraindications to vaginal delivery (e.g. placenta praevia)
Success rate of VBAC
75%
Prophylaxis for VTE
Early mobilisation
Anti-embolism stockings or intermittent pneumatic compression of the legs
Low molecular weight heparin (e.g. enoxaparin)
Measures to reduce the risks during Caesarean section
H2 receptor antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) before the procedure - prevents acid reflux and aspiration pneumonitis
Prophylactic antibiotics during the procedure to reduce the risk of infection
Oxytocin during the procedure to reduce the risk of postpartum haemorrhage
Venous thromboembolism (VTE) prophylaxis with LMWH
