Caesarean Section

Question 1

What is a caesarean section?

Answer 1

Is the delivery of the fetus, placenta and membranes through surgical incision in the abdominal wall and uterus
(Mayes 2012)

Question 2

Examples of indications of CS

Answer 2

• Hypertensive disorders
• Fetal distress
• Failure or delay in progress
• Malpresentation
• Cord prolapse
• APH
• Uterine rupture
• Failed instrumental
  (Mayes 2012)

Question 3

Categories of CS

Answer 3

CAT 1 = immediate threat to life of the women or fetus - up to 30 minutes 
CAT 2 = maternal or fetal compromise which is not immediately life threatening - 30 to 75 minutes 
CAT 3 = no maternal or fetal compromise but needs early delivery
CAT 4 (elective) = delivery timed to suit women or staff
(NICE 2019)

Question 4

Preparation for CS

Answer 4

- Offer a haemoglobin 
  assessment to identify those 
  who have anaemia. 
  Although EBL of more than 
  1000mls infrequent after CS 
  (4-8%)
- Pregnant women who are 
  healthy and have otherwiese 
  uncomplicated pregnacies 
  shouldn't be routinely 
  offered G&S, crossmatching 
  of blood, clotting and USS to 
  localise placenta 
- Indwelling urinary catheter is 
  required to prevent over 
  distension of the bladder
- To reduce the risk of 
  aspiration, women should be 
  offered antacids and drugs 
  to reduce gastric volume and 
  acidity before CS
- Antibiotic prophylaxis before 
  skin incision due to the 
  reduced risk of maternal 
  infection and no effect on 
  baby demonstrated
(NICE 2019)

Question 5

What is the risk of fetal lacerations?

Answer 5

2%

NICE 2019

Question 6

What type of incision is used when doing CS?

Answer 6

A lower segment CS is the most frequently performed through suprapubic transverse incision. This is the method of choice as there is a low incidence of wound dehiscence together with an excellent cosmetic appearance
(Mayes 2012)

Question 7

Third stage management in CS

Answer 7

Give 5 IU of oxytocin by slow intravenous injection to encourage contraction of the uterus and to decrease blood loss. Controlled cord traction rather than manual removal as this reduces the risk of endometritis
(NICE 2019)

Question 8

When should a paediatrician be present at CS?

Answer 8

If performed under GA or where there is evidence of fetal compromise
(NICE 2019)

Question 9

Observations post CS

Answer 9

Respiration rate, heart rate, blood pressure, pain and sedation:
- 15 minutes for 30 minutes 
- Half hourly for 2 hours 
- Hourly if observations stable 
Then move to 4 hourly obs 
(NICE 2019)

Question 10

VTE assessment

Answer 10

Women having CS should be offered thromboprophylaxis because they are at increased risk of venous thromboembolism
(NICE 2019)

Question 11

When should the dressing be removed?

Answer 11

After 24 hours

NICE 2019

Question 12

What are the potential risks for having CS?

Answer 12

An RCOG (2015) information leaflet for women having CS states there is a risk of wound infection, blood clots and more bleeding than expected. The most common problem affecting babies is temporary breathing difficulties and babies more likely to need care in NNU. Babies are more likely to develop asthma in adulthood and to become overweight.

Question 13

More than 3 CS carries serious risk of …

Answer 13

Damage to bowel or bladder (1 in 1000) or utreter (3 in 1000)
Extra procedures such as a blood transfusion or emergency hysterectomy
Higher chance of placenta accreta
Increased chance of stillbirth in future pregnancy