Caesarean Section Flashcards
Medical indications for C-Section
Breech presentation
Multiple pregnancy
Transmission of blood borne viruses
Placenta praevia
Morbidly adherent placenta
Indication for emergency C-Section
Cord prolapse
Antepartum haemorrhage
Foetal distress
Failure to progress
Categories of C-Section
Pre-operative C-Section considerations
Blood tests: all patients require a full blood count to identify anaemia pre-operatively. Haemorrhage is a complication of caesarean section with blood loss > 1000ml occurring in around 4-8% of cases. According to NICE, patients who are otherwise well do not require group and saves or clotting screens pre-operatively.
Urinary catheter: a urinary catheter should be placed, particularly in patients undergoing regional anaesthesia.
Regional vs general anaesthesia for C-Section
Regional anaesthesia is the preferred method. It has been found to be safer for both mother and baby when compared to general anaesthesia.
Some patients require general anaesthesia. Clinicians have to be aware of the risk of failed intubation and aspiration pneumonitis. PPIs / H2 receptor antagonists should be offered prior to GA to reduce the risk of aspiration pneumonitis.
Mendelson Syndrome - what is this?
Mendelson Syndrome - it is an eponymous name for chemical pneumonitis secondary to aspiration of stomach contents during general anaesthesia. It is more common in pregnant women.
C-Section Procedure
Prophylactic antibiotics are given prior to knife to skin. The operating table should be placed at a 15-degree left tilt to reduce the risk of maternal hypotension.
There are a number of surgical approaches. A NICE document details these and the confusion that sometimes results, in short:
Transverse incision: defined by NICE as a ‘straight skin incision, 3 cm above the symphysis pubis; subsequent tissue layers are opened bluntly and, if necessary, extended with scissors and not a knife’. This is the preferred approach, it is thought to reduce operating times and post-operative febrile morbidity.
Pfannenstiel incision: a curved transverse incision is made in the skin crease about 2-3cm above the pubic symphysis. Tissue layers are then opened bluntly.
Following delivery of the baby in C-Section, the placenta is removed with controlled … …
Following delivery of the baby, the placenta is removed with controlled cord traction.
Serious maternal risks of C-Section
Need for emergency hysterectomy (uncommon, around 7-8/1000)
Need for further surgery e.g. curettage (uncommon, around 5/1000)
Venous thromboembolism (rare, around 4-16/1000)
Bladder / ureteric injury (uncommon, bladder injury around 1/1000, ureteric 3/1000)
Death (very rare, around 1/12000)
Frequent maternal risks of C-Section:
Abdominal/wound discomfort in the months following surgery
Risk of further caesarean section being needed during subsequent attempts at vaginal delivery
Infection
Haemorrhage
Need for hospital readmission
Maternal risks in future pregnancies after C-Section include:
Increased risk of uterine rupture in future pregnancies
Increased risk of antepartum stillbirth
Risk of placenta praevia and placenta accreta in future pregnancies increased
. Lacerations of the foetus affect around … out of every 100 caesarean sections.
Lacerations of the foetus affect around 1-2 out of every 100 caesarean sections.
Future pregnancies after C-section
The risks and benefits of further caesarean sections and vaginal births should be explained. Maternal wishes must be taken into account.
Women who have had 4 or fewer caesarean sections do not have an increased risk of fever and surgical injuries based upon the ‘planned mode of delivery’. Though the risk of uterine rupture is higher in those with planned vaginal birth, it remains rare.
Those who choose planned vaginal births should have CTG monitoring and receive care at a facility able to handle emergency sections with on-site transfusion services.
