Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 4 - GOSH > Caesarian Section > Flashcards

Caesarian Section Flashcards

1
Q

What does a C-section involve?

A

A surgical operation to deliver the baby via an incision in the abdomen and uterus.

This can be elective or emergency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What anaesthetic is an elective c-section usually performed under?

A

Regional anaesthetic – this is usually a ‘topped-up’ epidural or a spinal anaesthetic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is an elective c-section usually performed?

A

After 39 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some indications for an elective c-section?

A

1) previous C-section

2) symptomatic after a previous perineal tear

3) placenta praevia

4) vasa praevia

5) breech presentation (at term)

6) multiple pregnancy

7) uncontrolled HIV infection (transmissible)

8) cervical cancer

9) other malpresentations:
- unstable lie (a presentation that fluctuates from oblique, cephalic, transverse etc.)
- transverse lie
- oblique lie

10) maternal medical conditions (e.g. cardiomyopathy): where labour would be dangerous for mother

11) Primary genital herpes (herpes simplex virus) in the third trimester

12) foetal compromise e.g. early onset growth restriction and/or abnormal fetal Dopplers

13) previous major shoulder dystocia

14) maternal diabetes with a baby estimated to have a fetal weight >4.5 kg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

There are four categories of emergency caesarean section.

What are they?

A

1, 2, 3 and 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe a category 1 c-section

A

Immediate threat to the life of the woman or fetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the decision to delivery time in a category 1 c-section?

A

30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe category 2 c-section

A

There is not an imminent threat to life, but caesarean is required urgently due to compromise of the mother or baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the decision to delivery time in a category 2 c-section?

A

75 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe a category 3 c-section

A

No maternal or fetal compromise but needs early delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe a category 4 c-section

A

This is an elective caesarean - delivery timed to suit woman or staff.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Planned Caesarean sections for breech presentation at term have increased significantly since what?

A

The ‘term breech trial’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is placenta praevia?

A

‘Low-lying placenta’ where the placenta covers, or reaches the internal os of the cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is Primary genital herpes (herpes simplex virus) in the third trimester an indication for an elective c-section?

A

As there has been no time for the development and transmission of maternal antibodies to HSV to cross the placenta and protect the baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are elective c-sections usually performed after 39 weeks gestation?

A

To reduce respiratory distress in the neonate: known as Transient Tachypnoea of the Newborn (TTN).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

For those where delivery needs to be expedited prior to 39 weeks’ gestation, what should be considered?

A

Administration of corticosteroids to the mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Role of giving corticosteroids in delivery <39 weeks gestation?

A

This stimulates development of surfactant in the fetal lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 2 main types of c-section?

A

1) lower segment (99%)

2) classic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does a classic c-section involve?

A

longitudinal incision in the upper segment of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most commonly used skin incision in c-section?

A

Transverse lower uterine segment incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Before a c-section, what basic steps should be performed?

A

1) FBC

2) Group & Save (G&S)

3) H2-receptor antagonist (e.g. Ranitidine) +/- metoclopramide

4) VTE risk score calculated for each woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the average blood loss at c-section?

A

500-1000ml –> depending on many factors, especially the urgency of the operation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is a H2 receptor antagonist (e.g. ranitidine) +/- metoclopramide given as prophylaxis in c-section?

A

Ranitidine –> Decreases gastric acid secretion and may decrease gastric volume.

Metoclopramide –> An anti-emetic that increases gastric emptying).

This reduces the risk of aspiration of gastric contents into the lungs, leading to chemical pneumonitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pregnant women lying flat for a Caesarean section are at risk of Mendelson’s syndrome.

What is this?

A

This is aspiration of gastric contents into the lung, leading to a chemical pneumonitis.

This is because of pressure applied by the gravid uterus on the gastric contents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is the risk of Mendelson’s syndrome in c-section reduced?

A

1) H2 receptor antagonist (e.g. ranitidine) +/- metoclopramide

2) PPIs as an alternative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

After calculating the VTE score prior to c-section, what may be prescribed?

A

1) Anti-thromboembolic stockings or intermittent pneumatic compression of the legs

2) +/- low molecular weight heparin e.g. enoxaparin

3) Early mobilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is sometimes a general anaesthetic required in c-section?

A

1) Can be because of a maternal contraindication to regional anaesthetic

2) Failure of reginal anaesthesia to achieve the required block

3) More commonly because of concerns about fetal wellbeing and the need to expedite delivery as soon as possible (often the case for Category 1 sections).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some risks associated with having an anaesthetic?

A

1) Allergic reactions or anaphylaxis

2) Hypotension

3) Headache

4) Urinary retention

5) Nerve damage (spinal anaesthetic)

6) Haematoma (spinal anaesthetic)

7) Sore throat (general anaesthetic)

8) Damage to the teeth or mouth (general anaesthetic)

29
Q

How is the woman positioned in a c-section?

A

The woman is positioned with a left lateral tilt of 15° –> to reduce the risk of supine hypotension due to aortocaval compression.

30
Q

What should be inserted in a c-section when the anaesthetic is ready?

A

An indwelling Foley’s catheter: to drain the bladder and to reduce the risk of bladder injury during the procedure.

31
Q

Give general overview of the operative procedure in a c-section

A

1) The woman is positioned with a left lateral tilt of 15°

2) An indwelling Foley’s catheter is inserted

3) Skin is prepared using an antiseptic solution and antibiotics are administered just prior to the ‘knife to skin’ incision.

4) Skin incision

5) Sharp or blunt dissection into the abdomen

6) The visceral peritoneum covering the lower segment of the uterus is then incised and pushed down to reflect the bladder, which is retracted by the Doyen retractor.

7) Uterine incision is made on the lower uterine segment beneath the line of peritoneal reflection.

8) The baby is then delivered cephalic/breech with fundal pressure from the assistant.

9) Oxytocin 5 units is given intravenously by the anaesthetist

10) The uterine cavity is ensured empty, then closed with two layers.

32
Q

What are the 2 possible incisions used in c-section?

A

1) Pfannenstiel incision

2) Joel-cohen incision

33
Q

What is a Pfannenstiel incision?

A

A curved incision two fingers width above the pubic symphysis.

34
Q

What is a Joel-cohen incision?

A

a straight incision that is slightly higher (this is the recommended incision)

35
Q

What type of incisions are Pfannenstiel and Joel-Cohen?

A

These are both transverse lower abdominal skin incisions.

36
Q

Sharp or blunt dissection into the abdomen is made through several layers in a c section.

What layers?

A

1) Skin & subcutaneous tissue

2) Camper’s fascia (superficial fatty layer of subcutaneous tissue)

3) Scarpa’s fascia, (deep membranous layer of subcutaneous tissue)

4) Rectus sheath, (anterior and posterior leaves laterally, that merge medially)

5) Rectus muscle

6) Abdominal peritoneum (parietal)

This reveals the gravid uterus (perimetrium, myometrium and endometrium) and then the amniotic sac.

37
Q

What is Camper’s fascia?

A

Superficial fatty layer of subcutaneous tissue.

38
Q

What is Scarpa’s fascia?

A

deep membranous layer of subcutaneous tissue

39
Q

In a c-section, the visceral peritoneum covering the lower segment of the uterus is then incised and pushed down to reflect the bladder.

What is the bladder retracted by?

A

The Doyen retractor.

40
Q

Where is the uterine incision made in a c section?

A

On the lower uterine segment beneath the line of peritoneal reflection.

This is a transverse curvilinear incision which is digitally extended.

41
Q

What may be required if if the lower uterine incision is poorly formed (rare)?

A

De Lee’s incision (lower vertical)

42
Q

How many units of oxytocin is given in c-section?

A

5 units IV

43
Q

Purpose of giving oxytocin in a c-section?

A

Oxytocin 5 units is given IV by the anaesthetist to aid delivery of the placenta by controlled cord traction by the surgeon.

44
Q

What is lochia?

A

Lochia is the vaginal discharge you have after giving birth. It contains a mix of blood, mucus and uterine tissue.

45
Q

What should be monitored after a c-section?

A

1) Obs on an early warning score chart

2) Lochia (per vaginal blood loss post delivery)

46
Q

What is encouraged to enhance recovery post c-section?

A

Early mobilisation, eating and drinking and removal of catheter.

47
Q

A vertical incision down the middle of the abdomen is also possible in c-section, but this is rarely used.

When may this be used?

A

In certain circumstances, such as very premature deliveries and anterior placenta praevia.

48
Q

Benefits of blunt over sharp dissection into the abdomen in a c-section?

A

Blunt:
- involves using fingers, blunt instruments and traction to tear the tissues apart, rather than to cut them with sharp tools such as a scalpel.
- less bleeding, shorter operating times and less risk of injury to the baby

49
Q

Purpose of blunt dissection in a c section?

A

Used after the initial incision with a scalpel to separate the remaining layers of the abdominal wall and uterus.

50
Q

The baby is delivered by hand in a c-section, with the assistance of what?

A

Pressure on the fundus.

Forceps may be used if necessary.

51
Q

What are 4 measures taken to reduce the risks during c-section?

A

1) H2 receptor antagonists (e.g. ranitidine) or proton pump inhibitors (e.g. omeprazole) before the procedure

2) Prophylactic antibiotics during the procedure to reduce the risk of infection

3) Oxytocin during the procedure to reduce the risk of postpartum haemorrhage

4) Venous thromboembolism (VTE) prophylaxis with low molecular weight heparin

52
Q

Purpose of oxytocin in c-section?

A

reduce the risk of PPH

53
Q

What are some immediate complications of a c-section?

A

1) PPH (>1000ml)

2) Wound haematoma

3) Intra-abdominal haemorrhage

4) Bladder/bowel trauma

5) Neonatal:
- transient tachypnoea of the newborn
- fetal lacerations (1-2% risk, higher with previous membrane rupture)

54
Q

What does a primary Caesarean section reduce the risk of compared to a vaginal birth?

A

Reduced risk of:

1) perineal trauma and pain

2) urinary and anal incontinence

3) uterovaginal prolapse

4) late stillbirth

5) early neonatal infections

55
Q

Who is the risk of wound haematoma in c-section more common in?

A

Patients with large BMI, diabetes, immunosuppressed.

56
Q

Who is the risk of bladder or bowel trauma in c-section more common in?

A

More common in patients who have had previous abdominal surgery.

57
Q

What are some infections that may be 2ary to a c-section?

A

1) UTI

2) endometriosis

3) respiratory (higher risk if general anaesthetic used)

58
Q

Intermediate complications after a c-section?

A

1) Infection

2) VTE

59
Q

What are some late complications of a c-section?

A

1) Urinary tract trauma (fistula)

2) Subfertility (there is a delay in conceiving compared to women who have had vaginal deliveries)

3) Regret and other negative psychological sequelae

4) Rupture/dehiscence of scar at next labour (VBAC)

5) Placenta praevia/accreta

6) Caesarean scar ectopic pregnancy

60
Q

How is fertility affected in c-section vs vaginal delivery?

A

There is a delay in conceiving post c-section compared to women who have had vaginal deliveries.

61
Q

Potential effects on future pregnancies post c-section?

A

1) Increased risk of repeat caesarean

2) Increased risk of uterine rupture

3) Increased risk of placenta praevia

4) Increased risk of stillbirth

62
Q

Is it possible to have a vaginal birth after a previous caesarean section (VBAC)?

A

Yes, provided the cause of the caesarean is unlikely to recur.

63
Q

What is the success rate of VBAC?

A

75%

64
Q

What is the uterine scar rupture risk in VBAC?

A

0.5%

65
Q

Contraindications for VBAC?

A

1) previous uterine rupture

2) classical caesarean scar (a vertical incision)

3) other usual contraindications to vaginal delivery (e.g. placenta praevia)

66
Q

What should all women undergoing VBAC should have?

A

Continuous electronic fetal monitoring by CTG in labour as a change in fetal heart rate can be the first sign of impending scar rupture.

67
Q

What increases the risk of uterine scar rupture in VBAC?

A

Risks of scar rupture is higher in labours that are augmented or induced with prostaglandins or oxytocin.

68
Q
A

Yr 4 - GOSH (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions