Cesarean delivery

Question 1

what are maternal indications (9)

Answer 1

1. obstructed labor- CPD
2. placenta previa
3. placenta abruptio with fetal distress
4. previous myomectomy
5. 2> previous c/s deliveries
6. active HSV
7. high HIV viral load
8. extensive/ obstructive vulvovaginal warts
9. failed IOL where urgent delivery is indicated- severe pre eclampsia/ eclampsia/ multiple gestation with mal presentation of leading fetus

Question 2

what are fetal indications (5)

Answer 2

1. abnormal lie
2. malpresentation
3. fetal distress
4. cord prolapse with pulsating cord
5. cervical dystocia

Question 3

what skin incisions can you do

Answer 3

Transverse skin incision (i.e., Cohen, Pfannenstiel) preferred

Question 4

what uterine incision is preferred

Answer 4

low transverse incision (kerr)

Question 5

when would you do a classical incision (4)

Answer 5

1. for poorly formed
   lower segment (i.e., extreme prematurity)
2. transverse lie with fetal back down
3. conjoined twins
4. inaccessible lower segment (i.e. dense adhesions, large leiomyoma) or cancer of cervix