CAESARIAN SECTION Flashcards
What is the classical type of caesarian section?
Midline uterine incision
What is the most common type of caesarian section?
Lower segment caesarian section
When might the classical type of caesarian section be indicated?
Preterm delivery with a poorly formed lower segment
Preterm abnormal lie
Why are classical type caesarian sections rarely used nowadays?
Higher rates of haemorrhage and rupture (5%) in future labours
What are the maternal indications for lower segment caesarian section (LSCS)?
Two previous LSCS (out of date now, but still offered)
Placenta praevia
Fulmination pre-eclampsia
Maternal request - anxiety
Active primary genital herpes simplex virus
HIV disease depending on viral load
What are the fetal indications for lower segment caesarian section (LSCS)?
Breech presentation or unstable lie
Twin pregnancy when twin 1 presentation is not cephalic
Abnormal CTG in 1st stage of labour
Abnormal FBS in 1st stage of labour
Cord prolapse
Delay in first stage of labour eg due to malpresentation
When is an elective caesarian section usually performed?
39 weeks or more
Which is more commonly used in caesarian section, general anaesthesia or local anaesthesia?
Local
What are the steps of lower segment caesarian section?
Low transverse skin incision
Rectus sheath is cut and muscles divided
Uterovesical peritoneum is incised to allow bladder to reflected inferiorly
Lower uterine segment is incised transversely
Intravenous oxytocin given
Membranes removed
Everything is closed up making sure there is no haemorrhage
What are the complications associated with lower segment caesarian section?
Haemorrhage: all patients should be G+S
Gastric aspiration
Visceral injury - damage to bladder, bowel
Infection
VTE
Future pregnancy complications
Following a previous caesarian section, what is the success rate of future NVD (also termed VBAC - vaginal birth after caesarian)?
70% almost the same as NVD without previous c-section
