Caesarian Section

Question 1

Antepartum maternal indication of Caesarian section?

Answer 1

• 2 prior CS
• Uterine surgery
• Pelvic anomaly
• Prior obstetric anal sphincter injury
• Prior shoulder dystocia
• Medical conditions e.g. cardiac lesions
• Obstetric conditions e.g. severe pre-eclampsia

Question 2

Antepartum, fetal indications of Caesarian Section?

Answer 2

• Fetal anomalies
• Macrosomia
• Malpresentation
• APH/ Abruption
• Severe IUGR
• Twins (if growth discordant or twin one not cephalic)
• Higher order multiples
• Abnormal placentation

Question 3

Intrapartum maternal indications of C section?

Answer 3

• Failure to progress/ obstructed labour
• Unsuccessful instrumental delivery
• Unsuccessful induction

Question 4

Intrapartum, fetal indications of C section?

Answer 4

• Fetal distress ( compromise)
• Cord prolapse
• Uterine rupture

Question 5

What is the patient preparation involved in a C section?

Answer 5

• Review maternal history & antenatal investigation
• Informed consent ( may be difficult in emergencies)
• IV acess and bloods
• Communication with OT/anesthetics/paediatricians
• Positioning the patient, supine with left lateral tilt
• urinary bladder drainage (IDC)
• Auscultation of fetal heart, confirm fetal presentation
• Antibiotic prophylaxis (ideally pre-incision)

Question 6

Name the three times of anaesthesia used for C section? List the details, advantages and disadvantages of each?

Answer 6

• Spinal
• Dense block
• predictable
• Rapid onset
• Cant top up
• Epidural
• Slower onset
• Less predictable
• can be topped up
• can be used for post op analgesia
• Generally only used if already insitu pre-op
• CSE used if benefits of both are desired
• general
• Highest risk, used when regional anaesthesia contraindicated or there is insufficient time
• Used when excessive blood loss is anticipated

Question 7

Technique for Caesarian section

Answer 7

• Skin incision (generally Pfannenstiel)
• Entry through fat, rectus sheath and peritoneum
• Creation of a bladder flap (bladder is reflected anteriorly)
• Incision into the uterus
• Delivery of the baby

Question 8

What drug is administered by the anaesthetist at the start of a C section?

Answer 8

Oxytocic

Question 9

What is involved in post operative care after C section?

Answer 9

• Adequate analgesia
• thromboprophylaxis
• TEDS, LMWH, etc
• Lactation support
• Mobilisation
• IV fluids/ diet
• IDC/ bladder care
• Physio
• Wound care
• Debriefing

Question 10

What are the complications of C section?

Answer 10

• Hysterectomy
• Blood loss, risk of transfusion of bloo dproducts
• Infection ( wound, endometritis, urinary, sepsis)
• Deep vein thrombosis/ PE
• Damage to adjacent organs
• Wound breakdown
• Abnormal placentation in future pregnancy
• Scar rupture in future pregnancy
• Regret/ psychological impact
• Death