Caesarian section Flashcards
What is a caesarian section?
Involves a surgical operation to deliver the baby via an incision in the abdomen and uterus.
It can be a planned procedure (elective caesarean) or performed where there are acute problems during the antenatal period or labour (emergency caesarean).
How is elective c-section usually carried out?
Involves a planned date on which a woman will come in for delivery.
Usually performed under a spinal anaesthetic, and is considered generally a very safe and routine procedure.
When in gestation is elective c-section typically carried out?
Usually these are performed after 39 weeks gestation.
What are some indications for elective c-section?
- Previous caesarean
- Symptomatic after a previous significant perineal tear
- Placenta praevia
- Vasa praevia
- Breech presentation
- Multiple pregnancy
- Uncontrolled HIV infection
- Cervical cancer
How many categories of emergency c-section are there?
4 categories
What are the 4 categories of emergency c-section?
Category 1: There is an immediate threat to the life of the mother or baby. Decision to delivery time is 30 minutes.
Category 2: There is not an imminent threat to life, but caesarean is required urgently due to compromise of the mother or baby. Decision to delivery time is 75 minutes.
Category 3: Delivery is required, but mother and baby are stable.
Category 4: This is an elective caesarean.
What are the 2 common incision sites for c-section?
Pfannenstiel incision is a curved incision two fingers width above the pubic symphysis
Joel-cohen incision is a straight incision that is slightly higher (this is the recommended incision)
Apart from the 2 main incision types, what other incision can be carried out and when would this be done?
A vertical incision down the middle of the abdomen is also possible, but this is rarely used.
It may be used in certain circumstances, such as very premature deliveries and anterior placenta praevia.
What is a spinal anaesthetic?
Involves giving an injection of a local anaesthetic (such as lidocaine) into the cerebrospinal fluid at the lower back. This blocks the nerves from the abdomen downwards.
What is the layer and level of the spinal cord where the epidural anaesthetic is used?
Injected into the epidural space between spinal vertebrae L3/L4.
What are the risks associated with having anaesthetic?
- Allergic reactions or anaphylaxis
- Hypotension
- Headache
- Urinary retention
- Nerve damage (spinal anaesthetic)
- Haematoma (spinal anaesthetic)
- Sore throat (general anaesthetic)
- Damage to the teeth or mouth (general anaesthetic)
Why are emergency c-sections regarded as being more risky than elective c-sections?
Emergency c-section usually performed in less controlled settings and for more acute indications (e.g. foetal distress).
What are some measures that could be carried out to reduce risks during c-section?
H2 receptor antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) before the procedure
Prophylactic antibiotics during the procedure to reduce the risk of infection
Oxytocin during the procedure to reduce the risk of postpartum haemorrhage
Venous thromboembolism (VTE) prophylaxis with low molecular weight heparin
Generic surgical risks of c-section?
- Bleeding
- Infection
- Pain
- Venous thromboembolism
Complications in postpartum period after c-section?
- Postpartum haemorrhage
- Wound infection
- Wound dehiscence (splitting open)
- Endometritis
