Caesarean Section Flashcards
2 types of incisions:
LSCS:
- What does this stand for?
- Pfannenstiel incision - where is the incision made in relation to the pubic symphysis?
- Joel Cohen incision - where is the incision made in relation to the pubic symphysis?
Lower segment CS
2cm above PS - curvilinear
1 cm higher - straight - fewer complications
2 types of incisions:
Classical CS:
- When is this needed? - 2
- What type of incision is made?
- What is vaginal delivery not attempted in subsequent pregnancies?
Why is a LSCS better than a classical CS?
If structural abnormalities
Very preterm baby
Vertical incision into the uterus
(with either transverse or vertical skin incision)
Risk of rupture
Fewer adhesion formations
Lower blood loss
Lower risk of scar dehiscence - wound reopening
What type of analgesia is used?
At what gestation is it preferred to be done at and why?
Spinal anaesthesia
39 wks - reduces neonatal respiratory problems
Indications - list some
Previous CS
Non-progressive labour
Breech presentation, including of 1st twin in multiple pregnancies
Fetal distress
Maternal disease
Infection prevention (HIV, HSV)
Placental malpositon - PP major
Indications for emergency CS - list some
What type of
FBS pH <7.2
Severe APH
Cord prolapse
GA may be required for very rapid anaesthesia
Category of CS: (Dependent on indications)
Category 1:
- What is this sometimes called?
- How quickly does the baby need to be delivered?
- Examples of causes for this?
Category 2:
- When is this used?
- How quickly does the baby need to be delivered?
Category 3:
- This is called pre-elective. What could this mean?
Category 4:
- What is this then called thinking about the previous 3?
- Over what gestation should this be done?
- What should be prescribed if it is done before this gestation?
Which category has increased chance of complications?
Crash CS - emergency
Within 30 minutes
Fetal bradycardia, placental abruption
If maternal or feral compromise not immediately life-threatening
Within 30-60 minutes
If the mother has PET or there is a failed induction
Elective CS
>39 wks
Corticosteroids
Category 1 - Emergency
Short term complications:
Standard surgical risks - 3
Acid aspiration pneumonitis is a risk. What can be prescribed to reduce this? - R
DVT - What can be done before and what can be done after to prevent this?
Infection:
- Type of infection
- What is prescribed?
Neonatal respiratory distress syndrome:
- What drug is given to prevent this?
- Route?
SSRI mneumonic used to remember these managements?
Bleeding
Trauma (baby or organs)
Abdominal pain (but less perineal pain than vaginal delivery)
Ranitidine
Stockings before
LMWH after
Endometritis and wound infection
Co-amoxiclav
Steroids IM
---- Steroids Stockings Ranitidine Infection prophylaxis
Long term complications:
Why is a VBAC not recommended after CS?
What type of CS can a VBAC not be tried after?
Other long term complications?
Risk of uterine rupture - worse with IOL
Classical CS --- PP Stillbirth Adhesions
Before an EMERGENCY section:
Why is sodium citrate given?
Why is metoclopramide given?
Why is a crossmatch and a group and save done?
To neutralise gastric contents
To promote gastric contents
If there is placental abruption and PP
