Caesarean Section

Question 1

Planned caeser may reduce

Answer 1

Perineal and abdominal pain in the first 3/7 PP
Injury to vagina
Early PPH
Obstetric shock

Question 2

Planned caeser may increase

Answer 2

NICU admission
Longer hospital stay
Hysterectomy caused by PPH
Cardiac arrest

Question 3

Hep C and HIV combined infection

Answer 3

Should offer a caeser

Question 4

Factors reducing the likelihood of cs

Answer 4

Continuous support during labour
IOL after 41 weeks in an uncomplicated pregnancy
Partogram with 4 hour action line
Consultant involvement
FBS

Question 5

Classifications of c/s

Answer 5

Cat 1:immediate threat to the life of the woman or fetus
2. Maternal or fetal compromise which is not immediately life-threatening
3/ no materna or fetal compromise but needs early delivery
4. Delivery timed to suit woman or staff

Question 6

Surgical incision

Answer 6

Transverse abdominal incision - less post op pain and improved cosmetic effect
Should be Joel Cohen/blunt entry - associated with shorter operating times and reduced post op febrile morbidity

Question 7

Risk of fetal laceration

Answer 7

2%

Question 8

Maternal request

Answer 8

Can do if they understand risks and benefits

Can decline to do if believe there are significant health concerns for mother or baby if do section OR mum doesn’t fully under stand risks —must refer for second opinion

Question 9

Risk of complications with c/s’s and instrumentals

Answer 9

Elcs 7%
EmCS 16.3%
Instrumental 13%

Question 10

Risks for future pregnancies with caeser

Answer 10

Delayed conception
Increased risk ectopic
IUGR
Preterm Ruth
Unexplained SB after 34 weeks
Uterine scar dehiscence or rupture

Question 11

Overall risk of antenatal, intrapartum, or neonatal death after 39 weeks (any pregnancy)

Answer 11

1. 4 in 1000

4. 6 per 1000 at 41 weeks gestation

Question 12

Cold section risks to baby

Pathophysiology behind this

Answer 12

TTN
Surfactant deficiency
Pulmonary hypertension

2.1 to 6.8 fold increase in risk

Surfactant deficiency caused by absence of the catecholamine surge accompanying labour and from a failure to clear fetal lung fluid in labour

2x more likely to go to NICU

Question 13

Risks to fetus at complicated delivery

Answer 13

Skull fracture and/or ICH following disimpaction
Brachial plexus palsy
Cervical spine, spinal cord and/or vertebral artery injury following delivery of the after coming head or a breech presentation

Question 14

Complication rates of cs in labour 1st and second stage vs elective

Answer 14

1st stage: 24 vs 16

2nd stage:33 vs 17

Question 15

Advantages of Joel Cohen entry

Answer 15

Less blood loss
Shorter delivery time
Less operating time
Less fever
Reduced post-op pain
Shorter hospital stay
Increased time to first dose of analgesia
Reduced total dosage of analgesia in the first 24 hours