Cesarean delivery Flashcards
What is a Caesarean delivery?
Caesarean delivery is the delivery of an infant through a uterine incision.
What are some indications for a Caesarean delivery?
Indications include obstructed labour, cephalopelvic disproportion, abnormal lie, malposition, malpresentation, placenta praevia, fetal distress, cord prolapse with pulsating cord, abruptio placenta with fetal distress, previous myomectomy, two or more previous Caesarean deliveries, high HIV viral load (> 1000 copies), extensive/obstructive vulvovaginal warts, primary active HSV, cervical dystocia, and failed induction of labour where urgent delivery is indicated.
What is the preferred type of skin and uterine incision for a Caesarean delivery?
The preferred type of skin incision is transverse (e.g., Cohen, Pfannenstiel), and the preferred uterine incision is low transverse (e.g., Kerr).
What is the recommended postoperative care after a Caesarean delivery?
Postoperative care includes monitoring vital signs, ensuring adequate IV fluids, providing analgesia, promoting early ambulation, considering thromboprophylaxis if at high risk for DVT, and removing the catheter within 24 hours unless otherwise indicated. Diet should start with fluids and progress to light meals once the patient is fully awake
When should prophylactic antibiotics be administered during a Caesarean delivery?
Prophylactic antibiotics should be administered 30-60 minutes prior to skin incision in theatre at the time of induction of anesthesia.
What are the common complications associated with a Caesarean delivery?
Complications can include infection, hemorrhage, injury to surrounding organs, thromboembolism, and complications related to anesthesia. There is also a risk of complications in future pregnancies, such as uterine rupture.
What antibiotics should be continued postoperatively if indicated?
If preoperative antibiotics were not given or in cases such as chorioamnionitis, contaminated Cesarean section, or prolonged labour, continue with first-line antibiotics such as Ampicillin and Gentamicin or second-line antibiotics such as Ceftriaxone and Flagyl.
When is the removal of permanent sutures recommended after a Caesarean delivery?
Suture removal is recommended on postoperative day 5 for a transverse skin incision and on postoperative day 7 for a midline skin incision.
When should elective Caesarean deliveries ideally be performed?
Elective Caesarean deliveries should ideally be performed during the weekday whenever possible.
What are the initial preoperative steps for a patient scheduled for a Caesarean section?
Initial steps include establishing IV access, sending blood for hemoglobin (Hb) levels, grouping and saving blood, and cross-matching if indicated (e.g., in cases of previous scar or antepartum hemorrhage).
What is a critical step that must be completed before proceeding with a Caesarean section?
Informed consent must be signed by the patient before proceeding with a Caesarean section.
Why is catheterization performed before a Caesarean section?
Catheterization is performed to monitor urinary output and to ensure an empty bladder during the surgery, reducing the risk of bladder injury.
What is the recommended timing for administering prophylactic antibiotics before a Caesarean section?
Prophylactic antibiotics should be administered 30-60 minutes prior to the skin incision in the operating theatre.
What IV fluid regimen is recommended during the first 24 hours post-Caesarean section?
The recommended IV fluid regimen during the first 24 hours includes either [5% dextrose 1 L + Ringer’s Lactate (RL) 1 L + Normal Saline (NS) 1 L] or [NS 2 L + RL 1 L] over 24 hours.
What are the options for prophylactic antibiotics before a Caesarean section?
Options for prophylactic antibiotics include Cefazolin (1-2g IV), Ampicillin (2g IV), X-Penicillin (3 million units IV), or Ceftriaxone (1g IV if other antibiotics are unavailable).
