Caesarean Section

Question 1

What are the 2 types of C-section?

Answer 1

1. Lower segment C-section
2. Classic C-section: longitudinal incision in the upper segment of the uterus

Question 2

What are indications for a C-section?

Answer 2

absolute cephalopelvic disproportion
placenta praevia grades 3/4
pre-eclampsia
post-maturity
IUGR
fetal distress in labour/prolapsed cord
failure of labour to progress
malpresentations: brow
placental abruption: only if fetal distress; if dead deliver vaginally
vaginal infection e.g. active herpes
cervical cancer (disseminates cancer cells)

Question 3

What are the categories of C-section?

Answer 3

Category 1
an immediate threat to the life of the mother or baby
examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
delivery of the baby should occur within 30 minutes of making the decision

Category 2
maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision

Category 3
delivery is required, but mother and baby are stable

Category 4
elective caesarean

Question 4

What are serious maternal risks of a C-section?

Answer 4

emergency hysterectomy
need for further surgery at a later date, including curettage (retained placental tissue)
admission to intensive care unit
thromboembolic disease
bladder injury
ureteric injury
death (1 in 12,000)

Question 5

What are risks of a C-section to future pregnancies?

Answer 5

increased risk of uterine rupture during subsequent pregnancies/deliveries
increased risk of antepartum stillbirth
increased risk in subsequent pregnancies of placenta praevia and placenta accreta)

Question 6

What are frequent maternal risks of a C-section?

Answer 6

persistent wound and abdominal discomfort in the first few months after surgery
increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies
readmission to hospital
haemorrhage
infection (wound, endometritis, UTI)

Question 7

What are fetal risks of a C-section?

Answer 7

lacerations, one to two babies in every 100

Question 8

Who is a VBAC (vaginal birth after caesarean) for?

Answer 8

planned VBAC is an appropriate method of delivery for pregnant women at >= 37 weeks gestation with a single previous Caesarean delivery
around 70-75% of women in this situation have a successful vaginal delivery

Question 9

When is VBAC contraindicated?

Answer 9

previous uterine rupture or classical caesarean scar