Caesarean section Flashcards
What is a caesarean section? (Hayman 2015)
an operative procedure which is carried out under anaesthesia (regional or general), whereby the fetus, placenta and membranes are delivered through an incision made in the abdominal wall and uterus’
What has caused rise in caesarean section rate?
Obesity and age
What are reasons for an elective c section?
Past obstetric history
Previous CS
Previous 4th degree tear/OASIS
Previous difficult shoulder dystocia
Current pregnancy
Breech
Placenta praevia
Active herpes
Fetal condition (may become stressed in labour)
Multiple pregnancy
Maternal choice
What is involved in antenatal preparation for ELCS?
Discussion at ANC and date set
Pre-operative assessment:
- Informed consent
- Observations of BP, urinalysis, weight
- Bloods taken for FBC, G & S ( X match if necessary) -Anaesthetic discussion and plan
- Discuss eating and drinking prior to procedure
What is involved in pre-op intrapartum care?
Attend at required time and venue
Pre-operative medication taken (anti-acid- phenergan/ranitidine)
Prepared for theatre (nail varnish/make up removed, gown, jewellery removed, pubic hair prep)
Catheterised
Anaesthetic administered
Partner present (gown)
Skin prepared and cleaned
IV antibiotics given during surgery
Staff present in ELCS?
Surgeons Anaethetist Scrub nurse/midwife Receiving midwife ?paediatrician/ANNP/neonatal nurse ODP/theatre nurse Partner
What is the delivery procedure?
Incision - usually transverse lower segment
Layers that need to be incised: skin, subcutaneous fat, rectus sheath, (rectus abdominus (muscle) is parted), abdominal peritoneum, uterus (muscle)
The peritoneum above the bladder is incised and the bladder moved out of the way (reflected down)
The uterine muscle should be incised carefully to avoid trauma to the fetus (NB amniotic fluid)
The surgeon then delivers the baby whilst the surgeon’s assistant applies fundal pressure
What is the procedure once the baby has been delivered?
Cord then clamped and cut
Baby dried and passed to parents (paediatrician if necessary)
Skin to skin encouraged in theatre
Oxytocin IV (5iu) (NICE 2011)
Placenta and membranes delivered
Uterus closed in 2 layers, rectus sheath and skin sutured
Wound dressed
Vagina swabbed to remove clots
What postnatal care is offered after an elective section?
Post operative recovery observations (BP, P, R, T, wound, lochia, pain)
15 mins for 30 mins, then 30 mins for 2 hours, hourly then 4 hourly
Thromboprophylaxis (NICE 2011)
Pain relief Bladder care
Skin to skin encouraged
Breastfeeding support
Wound assessment and care
Postnatal exercises and PFE encouragement
What are the potential risks with a caesarean section?
Increased morbidity/mortality
Increased risk of VTE
Increased risk of post-operative infection (wound, UTI, uterine, genital tract)
Increased blood loss, increased risk postnatal anaemia
Tiredness
Pain
Psychological support
What is a classical incision and why would it be used?
Malpresentation
Anterior placenta previa
Non-reassuring FHR
Cervical cancer
Inability to access the lower uterine segment due to lack of sufficient development (eg, extreme prematurity)
Adhesions (fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connects tissues not normally connected)
Myomas (benign tumors composed partly of muscle tissue. Seldom develop in the cervix but when they do they’re sually accompanied by myomas in the larger upper part of the uterus. Myomas in this part of the uterus are also called fibroids.)
Obesity
Babies with abnormalities
(associated with much higher maternal, e.g. uterine rupture and fetal complications)
What is a Category 1 cs?
where conditions are life- threatening to the mother or baby for example in the case of cord prolapse, uterine rupture, separation of the placenta or acute and severe fetal distress. In this case the caesarean will be done within half an hour. This is sometimes called a “Crash Section”, and is unusual and quite dramatic. It may sometimes need a General Anaesthetic.
What is a Category 2 cs?
where there is a threat to the maternal or fetal condition. But not immediately life-threatening. The caesarean will normally be done within one hour. Examples of reasons for a grade 2 section include; failure to progress in the first or second stage of labour, failed instrumental delivery, non-reassuring fetal heart abnormalities. This is generally done with a Spinal or epidural anaesthetic.
What is a Category 3 cs?
Today , not tomorrow, within the next couple of hours – for example with failure to progress when the baby is well, or where a caesarean is planned but the mother has gone into labour, or a previously undiagnosed breech baby.
What is a Category 4 cs?
usually Planned or Elective, generally performed at the convenience of parents ,staff and theatre, and often done as a formal operating list.
