Caesarean Section

Question 1

In the UK, what percent of nulliparous women deliver by CS?

Answer 1

24%

Question 2

Is having a previous CS the biggest predictor of having another CS?

Answer 2

Yes - 67% in the next pregnancy - mostly elective

Question 3

What is the maternal mortality?

Answer 3

1 per 100,000

Question 4

What is a first CS usually due to?

Answer 4

Failure to progress
Fetal distress
Breech presentation

Question 5

What types are there?

Answer 5

Lower uterine segment incision

Classical CS

Question 6

Describe a lower uterine segment incision

Answer 6

Joel Cohen skin incision - straight incision 3cm above symphysis pubis with blunt dissection after

Question 7

Is LSCS more common or classical?

Answer 7

LSCS - comprises 99% of cases

Question 8

Describe a classical CS

Answer 8

Longitudinal incision in upper segment of uterus

Rarely used

Question 9

What indications are there for classical CS?

Answer 9

Very premature fetus
Lower segment poorly formed
Fetus lies transverse with ruptured membranes
Structural abnormality makes lower segment use impossible
Fibroids positioned for make LSCS impossible
Some anterior placenta praevias
Maternal cardiac arrest and rapid birth desired

Question 10

A classical CS is associated with more…

Answer 10

Adhesion formation
Infection
A contraindication to subsequent vaginal delivery

Question 11

What indications are there for a LSCS?

Answer 11

Repeat CS
Fetal compromise e.g bradycardia, scalp pH<7.2, cord prolapse
Failure to progress in labour
Malpresentation
Severe pre eclampsia
Absolute cephalopelvic disproportion
IUGR
Placenta praevia
Placenta abruption if fetal distress, if dead deliver vaginally
Vaginal infection e.g active herpes
Cervical cancer - disseminates cancer cells

Question 12

What is a category 1 CS?

Answer 12

For immediate threat to life of fetus or woman
Baby should be delivered in 30 mins of decision
E.g placental abruption, fetal bradycardia

Question 13

What is category 2 CS?

Answer 13

For maternal or fetal compromise not immediately life threatening
30-60mins
E.g failure to progress

Question 14

What is a category 3 CS?

Answer 14

Thought of as semi elective

Pre eclampsia or failed induction

Question 15

What is category 4 CS?

Answer 15

Elective e.g term singleton breech

Question 16

When should electives be carried out?

Answer 16

After 39 weeks unless issue arise

Question 17

What intraoperative complications can occur with as CS?

Answer 17

Blood loss
Blood transfusion 
Bladder injury
Ureteral injury 
Bowel injury 
Emergency hysterectomy 
Need for further surgery at later date 
Thromboembolic disease 
Infection - wound, endometritis, UTI 
Increased risk of repeat CS when vaginal delivery attempted in subsequent pregnancies 
Persistent wound and abdominal discomfort in first few months after surgery

Question 18

What is there an increased risk of in future pregnancies after having a CS?

Answer 18

Uterine rupture
Antepartum stillbirth
Placenta praevia and accreta

Question 19

Every woman with emergency CS should have 7 days of prophylactic…

Answer 19

LMWH

Question 20

What fetal complications can occur?

Answer 20

Lacerations - 1 to 2 in every 100