Caesarean section Flashcards
Pros and cons of c-section
Cons: abdo pain, increased VTE risk, bladder/ ureteric injury, hysterectomy, maternal death
Pros: less perineal pain, uninary incontience and prolapse rates are lower
Maternal request accounts for what % of c-sections?
7%
Indications for c-section
Repeat c-sections
Foetal compromise
Malpresentation
Failure to progress
Multiple pregnancy
Uncontrolled HIV infection
Cervical cancer
Discuss c-section categories
Category 1: emergency, do within 30mins
Immediate threat to woman or baby e.g. abruption, cord prolapse, scar rupture, prolonged bradycardia, foetal hypoxia (<7.2pH)
Category 2: urgent, do within 90mins
Maternal or foetal compromise that isn’t immediately life threatening
No set time limit but standard is <90mins
Category 3: expedited
Woman who needs delivery early but no maternal or foetal compromise e.g. severe pre-eclampsia, IUGR, failed IOL
Category 4: elective
Offered after 39 weeks
Term singleton breech if ECV failed, twin pregnancy where 1st twin is non-cephalic, maternal HIV, primary genital herpes in 3rd trimester, placenta praevia
What is transient tachypnoea of the newborn?
Delayed clearance of foetal lung fluid after birth
Worse after c-section as vaginal delivery helps to squeeze fluid out
Worse at lower gestational age which is why elective c-sections are done >39 weeks
Types of skin incision used for c-section
1) Pfannstiel: straight horizontal incision 2 cm above symphysis pubis
2) Joel-Cohen: straight horizontal incision but higher than Pfannstiel, 3cm below anterior superior iliac spines. Quicker access
3) Classical CS: vertical midline incision, rarely used but allows for rapid delivery. Indications include structural anomaly of uterus, difficult to access lower segment e.g. fibroids, anterior placenta praevia, transverse lie with ruptured membranes
If a woman has had a c-section, can she go on to have a subsequent vaginal delivery?
Yes
BUT not if classical vertical incision was performed in c-section - this is an absolute contraindication to trial of vaginal delivery
Discuss complications associated with c-section
Intraoperative complications affect 12-15% women
- Lacerations
- Blood loss
- Bladder lacerations
- Bowel lacerations
- Hysterectomy
Post operative: endometritis, wound infection, VTE, UTI
Risk to subsequent pregnancies following c-section
Uterine rupture (1:200 with spontaneous labour)
Placenta praevia (47% increase compared to background risk)
Placenta accreta
Anterpartum stillbirth
What is given to women before c-section to prevent aspiration pneumonitis?
There is a risk of aspiration pneumonitis during caesarean section, caused by acid reflux and aspiration during the prolonged period lying flat.
H2 receptor antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) are given before the procedure
Interventions to reduce risk of morbidity due to c-section
- Pre-op Hb check - correct anaemia
- Prophylactic antibiotics
- VTE risk assessment
- In-dwelling catheter
- Regional > general anaesthesia
