Cesarean Section Flashcards
Rate of adhesions at umbilicus after midline incision?
55%
Rate of adhesions at umbilicus after low transverse incision?
23%
Do we need to do bladder dissection in case of classical cs
No
A subsequent trial of labour is allowed for women with previous classical caesarean section?
No it’s contraindicated due to risk of uterine rupture
rate of bladder injuries that need repair
1-100
Rate of CS deliveries
25%
15% emergency
10% elective
Most common causes of unplanned CS
Labor dystochia
Fetal hypoxia
Malpresentation
When HIV is an indication of CS
VL<50: vaginal - VBAC
VL 50-399: consider CS
VL>400: CS
Timing of CS in HIV pts
If bec. Prevention of vertical transmission: 38-39w
If bec. Of obs indications: >39w
If women requested CS d.t. Tokophobia
Refer to psychomental health
ECV should be offered for breech except
- in labour
- uterine scar or abnormalities
- fetal compromise
- ROM
- vaginal bleeding
- medical conditions
When to offer ECV in breech
36 w
If unsuccessful, declined orCI, offer CS
When to perform CS in multiple pregnancy
If the first not cephalic
CS indications in SGA
- Abnormal DV
- poor STV in cCTG
- AREDV
Do CS reduces risk of vertical transmission in women with hepatitis C
No
Offer CS IF: hepatitis C+ HIV
When to offer CS for HSV
In primary genital HSV in the 3rd trimester
Management of 1ry genital HSV IN 3rd trimester
Consider acyclovir 400 mg TDS until delivery
- planned CS
Do a BMI>50 alone an indication for CS
No
Timing of planned CS
Not before 39 w to reduce neonatal respiratory distress
Surgical site infection prevention
- Alcohol based chlorhexidine
- Alcohol based iodine
- AB before insicion (not coamoxiclav)
Best CS Incision
Joel cohen (3cm above SP)
Methods to assist cs in fully dilated women
- push method
- pull method (reverse breech extraction)
- patwardhan’s method
- fetal pillow
- C-snorkel
When do we routinely close subcutaneous tissue
If more than 2 cm
Indications of myomectomy with CS
- Fibroids causing difficulty with closure of the uterine incision
- to facilitate safe delivery of the fetus
- large fibroids greater than 6 cm in diameter
- visible subserosal fibroids
FINAL DECISION FOR VBAC should be made by what age
36 w
VBAC Success rate
75%
VBAC Success rates
Overall: 75%
Pvs vaginal delivery: 90%
Pvs cs dt fetal malpresentation: 84%
Pvs cs for fetal distress: 73%
Pvs cs for labor dystocia: 64%
Multiple risk factors: 40%
Risk of rupture uterus with VBAC
1/200
When neonatologist should be present in CS
1- cs perfromed under GA
2- where there is evidence of fetal compromise
Observation after recovery of anasthesia of cs
Rr,hr,bp every half hour for 2 hours and hourly after
Post cs monitoring of women with interthecal or epidural morphine or diamorphine
If + RF for respiratory depression: hourly o2 ,RR for 12 hours the local protocols
If no Rf: local protocol
When double drain is indicated after CS
If the patient receiving therapeutic LMWH
What type of analgesics avoided in breastfeeding
Avoid codeine and co-codamol as it can cause serious neonatal sedation and respiratory depression
Give dihydrocodeine tartrate
When to remove urinary catheter
-After regional: once woman is mobile
-Not sooner tahn 12 hrs After last epidural dose
Contraindications of VBAC
Pvs Rupture uterus
Pvs classical CS
Most significant sign of rupture uterus
Loss of station of the presenting part
Abnormal CTG
Classic triad pf complete uterine rupture
- Vaginal bleeding
- Pain
- Fetal HR Abnormalities
