Caesarean Sections Flashcards
Who defines CS?
Haymaker 2015
Fetus,placenta and membranes delivered through an incision in the abdominal wall
When woman may need to have EMCS?
Fetal distress Medical emergency (seizure, cardiac arrest) Sig Mec Prolonged bradycardia Multiple pregnancy- second twin unstable lie Malpresentation Cord prolapse Shoulder dystocia Placenta Praevia Uterine rupture Failed instrumental Failure to progress Obstructed labour
EMCS CAT 1? NICE 2011
Within 30 minutes - immediate threat to life
EMCS cat 2?
NICE 2011
30 minutes to 75 minutes
Fetal or maternal demise
EMCS cat 3 and 4
No fetal demise.
Needs early deliver or delivery time to suit woman and hospital
Indications for ELCS
(NICE, 2011) Previous 4th degree tear Previous shoulder dystocia Breech Morbidly adherent placenta HIV with high viral load HIV Aand Hep c Active herpes Maternal request
How can midwives reduce the risk of ELCS?
NICE, 2011 Continuous support in labour IOL at 41 weeks Consultant decision CTG increases the risk of CS
Risks associated with CS
DVT
delayed lactogenesis 2 (pollard, 2011)
Increased
Preparation for EMCS?
Discussion and consent
Documentation
FBC, G&S (in case of blood transfusion. Cross match if necessary)
Anaesthetist discussion and plan (antacids)
Abx prophylaxis
Prep for theatre
Skin cleaned and prep
Staff present in CS
Surgeon Receiving midwife Scrub nurse Paed ODP
What does NICE 2011 recommend about synto?
Recommended after CS to avoid PPH
PN Care for CS
Post operative obs BP, Pulse, resps, temp, wound, lochia, pain every 15 mins for 30 mins, every 30 minutes for 2 hours, hourly then 4 hourly
Thromboprophylaxis Pain relief Bladder care - catheter removal Skin-to-skin encouraged Breastfeeding support Wound assessment and care Postnatal exercises and pelvic floor exercises encouraged - may see physio Debrief
Risks associated with CS
VTE Increased mortality/morbidity Post operative infection - wound,UTI Increased blood loss and increased risk of anaemia Tiredness Pain Psych support
