Caesarean Section

Question 1

Indications for C/S

Answer 1

Multiple pregnancy w/ unstable lie
Previous classical c/s
Prev shoulder dystocia w/ signficiant injury
Prev pelvic floor or significant rectal damage
Obstetric History
Fetal disease that may make vaginal birth unfavourable
Placenta previa
Active herpes
Acute fetal distress
Maternal disease

Question 2

Risks for Mother with CS

Answer 2

Increased risk of PPH 
Risk of infection 
Risk of VTE 
paralytic illeus 
Post EDB/Spinal headache 
Incisional hernia

Question 3

Risks for Baby with CS

Answer 3

Resp problems 
Injury 
Nursery Admission 
Less skin to skin 
Delayed BF

Question 4

Name the routine pre op things for a woman having a c/s

Answer 4

Weight and Height 
Observations: BP, HR, TEMP, RR, 
Put on gown 
Make sure she is shaven 
Make sure she has two bands one on arm one on leg 
Ensure her notes are available 
Ensure her jewlery is removed/taped 
Ensure bloods have been taken and results are in 
Antacid therapy 
Fasting 
Chlorhex wash ? 
TEDS on 
Consent signed 
Cap on 
Catheterized 
Pre op check completed

Question 5

What are the layers that need to be incised in a LSCS

Answer 5

Skin and Subcut fat 
Rectus sheath 
Rectus muscles seperated 
Peitoneum opened and bladder deflected 
Uterus incised

Question 6

Why is the baby born slowly in a LSCS

Answer 6

to allow for elastic recoil of the lungs

Question 7

How is the placenta removed in a LSCS

Answer 7

active management 10U synto and CCT

40 U prophylactic due to ^ risk of PPH

Question 8

Categories of emergency LSCS

Answer 8

Cat 1: w/in 30 mins i.e cord prolapse, intrapartum haemorrhage, significant bradycardia, maternal collapse
Cat 2 A: w/in 60 mins e.g failed instrumental, abnormal FHR, scalp PH < 7.2
Cat 2 B: w/in 120 mins, FTP, placenta previa
Cat 3: w/in 6 hrs e.g. booked cs in early labour

Question 9

What are your immediate post op concerns in a LSCS

Answer 9

Airway Breathing Circulation

Question 10

Possible complications to be aware of in the immediate recovery period

Answer 10

N/V 
Hypoxia
Hypothermia 
Haemorrage and DIC
Nerve injuries 
Loss of consciousness

Question 11

Initial observation on admission to ward?

Answer 11

Assess wound on admission for ooze at least half hrly
Vaginal loss half hrly for two hrs
Regular assessment of Vital signs for at least 24 hrs
Regular Assessment of urinary output
Ensure she has adequate pain relief

Question 12

Midwives role in preventing wound infection

Answer 12

Regular assessment of ooze, dehiscence or infection signs i.e temp, pain, erythema and swelling
Educate the woman on wound care and teach hand hygiene

Question 13

Midwives role in preventing paralytic illeus

Answer 13

Avoid food or drink until peristaltic sound is heard from the bowel/passing of flatus
Most women can eat or drink once these sounds have been heard as they long as they have no N/V

IV Fluids can be discontinued when the woman is tolerating oral fluids and has begun postnatal diuresis

Question 14

Midwives role in preventing VTE & PTE

Answer 14

TED stockings
Hydration 
Early mobilisation 
Prophlyactic Clexane (?) 
Cal compressors (?) 
Provide education to the woman

Question 15

Midwives role in preventing bladder injury

Answer 15

Catheter removed when woman has full sensation

Fluid balance chart to be kept until the woman has voided 2 times with a volume of at least 300ml each time

Question 16

Midwives role in managing post operative pain

Answer 16

Women should be offered opiod analgesia for up to 48 h for pain relief
After this time oral analgesics such as panadol and anti-inflammatory medications should be offered. She should be encouraged to continue panadol and anti-inflammatory medication at home if she needs it