Caesarean Section

Question 1

INDICATIONS FOR VERTICAL INCISION(CLASSICAL CAESAREAN SECTION):

Answer 1

1. Transverse lie
2. Multiple fibroids
3. Extreme prematurity

Question 2

INDICATIONS(EMERGENCY C-SECTION):

Answer 2

1. Prolonged first stage of labour
   - full dilatation not imminent by 12h
2. Fetal distress

Question 3

INDICATIONS(ELECTIVE C-SECTION):

- done by 39w

Answer 3

1. Absolute: Placenta praevia, severe antenatal fetal compromise, uncorrectable abnormal lie, previous vertical C-section, gross pelvic deformity
2. Relative: Breech, severe IUGR, twin pregnancy, diabetes, other medical diseases, previous C-section, older nulliparous patients

*most common indications <34w are severe pre-eclampsia and severe IUGR

Question 4

COMPLICATIONS OF CAESAREAN SECTION:

a) Maternal
b) Fetal
c) Subsequent pregnancies

Answer 4

a) i) Serious:
- Emergency hysterectomy, need for further surgery at alter date, ICU admission, VTE, bladder and ureteric injury, death(1 in 12k)
ii) Frequent:
- haemorrhage
- infections(UTI, wound, endometritis)
- hospital readmision
- persistent wound and abdominal discomfort in first few months after surgery
- increased risk of repeat C-section when vaginal delivery attempted in subsequent pregnancies.
iii) Others: Ileus, subfertility due to post-op adhesions

b) Increased risk of fetal respiratory morbidity, implications on bonding and breastfeeding, lacerations)1-2%)
c) Small increase in stillbirth, placenta praevia, placenta accreta, increased risk of uterine rupture during subsequent pregnancies/deliveries

Question 5

OTHER INDICATIONS:

Answer 5

1. Absolute cephalopelvic disproportion
2. Malpresentation: brow
3. Placental abruption if fetal distress
4. Vaginal infection: active herpes
5. Cervical cancer

Question 6

VBAC

Answer 6

1. Recommended if previous C-section due to fetal distress
   - 70-75% successful
2. CI: previous uterine rupture and classical caesarean scar