Caesarean Section

Question 1

What pre-med should women be given prior to CS and why?

Answer 1

Histamine H2 receptor antagonists

To reduce gastric volumes and activity
Which in turn, reduces risk of aspiration pneumonitis

Question 2

Why is blunt extension of the uterine incision preferred to sharp extension?

Answer 2

Reduced blood loss
Reduced incidence of PPH
Reduced need for transfusion at CS

Question 3

Why is Joel-Cohen entry preferred?

Answer 3

Shorter operating time

Reduced post-operative febrile morbidity

Question 4

Why should the peritoneum not be closed?

Answer 4

Reduced operative time

Reduced need for post-operative analgesia

Question 5

When should the subcutaneous tissue spaced be closed

Answer 5

If the woman has more than 2cm subcutaneous fat

Question 6

What is the risk of complication at elective CS compared with emergency CS in labour and instrumental delivery?

Answer 6

Elective CS = 7%
Emergency CS = 16.3%
Instrumental vaginal delivery = 12.9%

Question 7

What are the fetal risks of a difficult delivery at CS

Answer 7

1. Skull fracture and/or intracranial haemorrhage following disimpaction where the head is deep in the pelvis
2. Brachial plexus palsy following difficult delivery of the shoulders in the presence of fetal macrosomia
3. Cervical spine, spinal cord and/or vertebral artery injury following delivery of the after coming head of a breech presentation

Question 8

What is the risk of emergency hysterectomy at CS?

Answer 8

7-8:1000

RCOG consent form

Question 9

What is the risk of bladder injury at CS?

Answer 9

1:1000

RCOG consent

Question 10

What is the risk of ureteric injury at CS?

Answer 10

3:10,000

RCOG consent form

Question 11

What is the risk of PPH at CS?

Answer 11

4-8%

NICE

Question 12

What is the risk of infection following CS?

Answer 12

6:100

RCOG consent form

Question 13

What is the risk of fetal laceration at time of CS?

Answer 13

1-2:100

RCOG consent form

Question 14

What were the findings of the Cochrane review looking at vaginal cleansing with antiseptic solution before CS delivery?

2020

Answer 14

Reduction in

• endometritis: larger effect for women in labour
• post-op fever
• wound infection

Well-tolerated

Question 15

What are the findings of the Cochrane review looking at placental delivery via CCT as opposed to MROP?

Answer 15

Less

• endometritis
• blood loss
• Hb drop
• duration of hospital stay

Question 16

What is the rate of CS?

Answer 16

25% in NZ

RANZCOG

Question 17

What factors reduce the likelihood of CS?

Answer 17

• Continuous intrapartum support from midwife or non-trained personnel.
• IOL after 41+0 in otherwise uncomplicated pregnancy.
• Use of partogram with 4 hour action line to monitor progress of labour.
• Involvement of SMO obstetrician in decision making for CS.
• Use of FBS when CTG is abnormal

Question 18

What are the fetal indications for an elective CS?

Answer 18

• Breech presentation

- Prevention of transmission of HIV, HSV, Hep C + HIV.