Caesearean Section

Question 1

What is LSCS?

Answer 1

Lower segment caesarean section

LSCS is a surgical procedure used in childbirth, involving an incision in the lower segment of the uterus.

Question 2

What are the advantages of LSCS?

Answer 2

Reduction of:
* rupture of the scar in a subsequent pregnancy
* risk of bleeding
* risk of peritonitis
* risk of paralytic ileus
* risk of bowel adhesion

These advantages make LSCS a preferred method in certain obstetric situations.

Question 3

What are the 5 most common causes of cesarean section (CS)?

Answer 3

1. Dystocia (non-progressive labor)
2. Routine repeat cesareans
3. Abnormal fetal presentation (e.g., breech, transverse, cord presentation)
4. Fetal distress
5. Cesarean section on request

These causes highlight the various clinical scenarios leading to the decision for a CS.

Question 4

List maternal indications for cesarean section.

Answer 4

• Pre-eclampsia/eclampsia
• Cardiac disease
• Cervical cancer
• Previous classical CS
• Full thickness myomectomy
• Cervical fibroid

These indications are critical for ensuring the safety of both mother and baby during delivery.

Question 5

What are fetal indications for cesarean section?

Answer 5

• Fetal malpresentation (breech, transverse lie, brow)
• Fetal distress
• Cord prolapse
• Fetal abnormalities (gastroschisis, omphalocele, meningomyelocele)

Understanding fetal indications is essential for timely and appropriate surgical intervention.

Question 6

What are the maternal/fetal indications for cesarean section?

Answer 6

• Cephalopelvic disproportion
• Failed induction of labor
• Abnormal uterine contraction

These indications often require careful assessment to avoid complications during delivery.

Question 7

List indications for classical cesarean section.

Answer 7

• Preterm delivery with poorly formed lower segment
• Placenta praevia/abruptio with large vessel in the lower segment
• Premature rupture of membranes, poor lower segment and transverse lie
• Transverse lie with back inferior
• Large cervical fibroid
• Severe adhesion in lower segment reducing accessibility
• Postmortem cesarean section

Classical cesarean sections are indicated in specific situations where the lower segment is not suitable for surgery.

Question 8

What are common risks associated with cesarean section?

Answer 8

• Persistent wound and abdominal discomfort (9 in 100)
• Increased risk of repeat CS when attempting vaginal delivery (1 in 4)
• Readmission to hospital (5 in 100)
• Hemorrhage (5 in 1000)
• Infection (6 in 100)

These risks emphasize the importance of monitoring and post-operative care.

Question 9

What are serious risks of cesarean section?

Answer 9

• Emergency hysterectomy (7-8 in 1000)
• Need for further surgery (5 in 1000)
• Admission to intensive care unit (9 in 1000)
• Thromboembolic disease (4-16 in 10,000)
• Bladder injury (1 in 1000)
• Ureteric injury (3 in 10,000)
• Death (1 in 12,000)

These serious risks necessitate a careful evaluation of the necessity for cesarean delivery.

Question 10

What is a common fetal risk associated with cesarean section?

Answer 10

Lacerations (1-2 babies in every 100)

Fetal risks must be considered when planning a cesarean section.

Question 11

What are future pregnancy risks after cesarean section?

Answer 11

• Increased risk of uterine rupture (2-7 in 1000)
• Increased risk of antepartum stillbirth (1-4 in 1000)
• Increased risk of placenta praevia and placenta accreta (4-8 in 1000)

These risks highlight the long-term considerations for women who have undergone a cesarean section.