Caesarean Section Flashcards
Fetal indications for C/S?
Fetal distress. Prolapsed cord with live baby. Abruptio no,ace ta with live baby. Transverse lie. Brow or mento-posterior face presentation. Breech presentation. Multiple pregnancy (especially monochorionic or abnormal lies). Macrosomia (esp. If associated with maternal diabetes). Certain congenital anomalies (hydrocephalus, gastroschisis).
Combined fetal and maternal indications?
Failure to progress (CPD, abnormal position)
Failed forceps or vacuum delivered
Failed induction of labour
What are the types of anaesthesia available
General.
Regional - epidural or spinal
Why is TLUCS the procedure of choice
Performed through a thin lower segment, gives good exposure and has the lowest complication rate
What are indications for a classical C/S?
Absent/ underdeveloped lower segment (e.g. In prematurity)
Inaccessible lower segment. Transverse lie. Anterior placenta praevia. Carcinoma cervix. Fibroids in lower segment.
What are the anaesthetic complications of C/S?
High spinal.
Failed intubation.
Aspiration.
Atelectasis.
Surgical complications of C/S?
Haemorrhage.
Trauma (bowel, bladder, ureter)
Sepsis (endometritis, wound)
VTE
What are contraindications to VBAC?
Previous classical C/S. Two or more previous C/S. Patient refusal. No recourse to emergency C/S. Very large baby. Malpresentation or other complication. Multiple pregnancy. Placenta praevia.
When can VBAC be attempted?
If the previous C/S was for non-recurring cause and the pelvis is adequate
What are the complications of VBAC?
Failure due to CPD, fetal distress or suspected scar dihiscence
Uterine rupture
In what situations would you suspect uterine rupture in a VBAC patient?
Severe LAP, especially when between contractions. Clinical evidence of hypovolaemic shock. Vaginal bleeding. Haematuria. Fetal distress.
What are maternal indications for C/S?
Major placenta praevia. Previous classical C/S. Previous uterine surgery. Cervical carcinoma. Serious medical conditions. Bearing down efforts contraindicated. Uterine rupture. Previous vaginal repair or surgery for urinary incontinence.
