Caesarean Sections Flashcards
What are the categories of CS?
- EMCS (immediate threat to life)
- EMCS (not immediately life threatening)
- EXCS (requires early delivery)
- ELCS
Give some reasons for choosing an ELCS
- Previous trauma
- Previous CS
- Placenta praevia
- Breech
- Health problems (e.g. heart condition)
- Maternal request
- Multiple pregnancy
What must be taken before a CS?
Antacid (e.g. Ranitidine, Omeprazole)
What other preparations must be undertaken?
- Check for caps, crowns, loose teeth, dentures
- Shave
- Hospital gown
- Fast for 12 hours if possible
- Catheterise in theatre
- G&S in last 72 hrs
What are the 2 types of incision?
- Transverse
2. Classical (can be of the uterus or the skin or both)
What are the pros and cons of a classical incision?
+ Easy access to baby (used for very high risk emergencies such as cardiac arrest)
- Scar is weaker
Which layers need to be cut?
- Skin
- Subcutaneous fat
- Rectus sheath
- Abdominal peritoneum
- Uterus
What is given intravenously during the operation?
- Antibiotics
- Oxytocin 5iu
- Fluids
What observations need to be done post-operatively?
- 5 mins x 4
- 15 mins x 2
- 30 mins for 2 hrs
- 4 hourly
What is a VBAC?
Vaginal Birth After Caesarean
What is the antenatal management for VBAC?
- Refer to consultant
- Scan to confirm placental site
- Counselling
What does having a VBAC reduce the risk of?
- RDS
- Complications in future pregnancies
What is the intrapartum management for VBAC?
- IV access and bloods
- Raised awareness of scar tenderness
- Continuous CTG
- Bladder care
What are the indicators for scar rupture?
- Abnormal CTG
- Severe, constant abdominal pain
- Scar tenderness
- Abnormal PV bleeding
- Cessation of contractions
- Signs of shock
These are ALL obstetric emergencies
What method of induction/augmentation has a lower risk of scar rupture?
Mechanical methods (e.g. ARM, foley catheter)
What are the risks of IOL for VBAC?
- 2-3x risk of uterine rupture
- 1.5x risk of CS
What happens if a pregnant woman had an extended incision in a previous CS?
She will be advised to have an ELCS as there is an increased risk of scar rupture
What bloods are required prior to a CS?
FBC and G+S within the last 72 hours
How long is the catheter left in after the surgery?
Min. 12 hours
When are women usually encouraged get up after the surgery?
After 6 hours
When should the scar dressings be changed?
Day 5 and 10 (off around day 14)
