Cesarean section Flashcards
What are maternal indications for cesarean sections?
Failure to progress
Cephalo-pelvic disproportion
Obstruction - fibroids, ovarian cysts,
Previous uterine surgery - myomectomy, classical C/S
Transmission of infection - HIV, HSV lesions
Significant maternal illness - Cardiac or resp disease, PE and eclampsia
What are Placental indications for cesarean section?
Placenta previa
Placental abruption
Vasa previa
Cord prolapse or cord presentation
What are fetal indications for cesarean section??
Presumed fetal distress Abnormal presentation or lie Fetal macrosomia Multipl pregnancy Gross fetal anomlay eg hydrocephaly
What are 3 advantages of a vertical skin incision?
Rapid entry into the abdominal cavity
Incision easy to extend
Easier to perform
What are 2 disadvantages or vertical skin incision
Greater incidence of dehiscence and hernias
Less cosmetically acceptable scar
What are 2 advantages of Pfannenstiel suprapubic incision?
More cosmetically acceptable scar
Less risk of hernia
What are 4 disadvantages of Pfennastiel suprapubic incision?
More time to perform
Surgical exposure could be difficult
Not easy to extend
Increased risk of wound haematoma
What are 4 disadvantages of classical Cesarean section?
Increased haemorrhage
Risk of rupture
Difficult surgical re-approximation of incision
Increased morbidity
What are 5 indications for classical cesarean section?
Lack of access to lower segment Postmortem Transverse lie Elective hysterectomy Major placenta previa
How do you manage a patient post op 24hrs
Vitals Fluids I/O charting ANalgesia Anti-emetics
How do you manage a patient post up day 1
Check vitals Talk to patient about procedure Examine patient listening to bowl sounds Sips of clear fluids and stop IVF if tolerated Remove catheter Breastfeeding Oral analgesic and antibiotics if needed
How do you manage a patient post up day 2
Start soft diet
How do you manage a patient post up day 3
Start normal diet
What are 5 anaesthetic complications?
Mendelson's syndrome Hypotension Hypothermia Temporary peripheral nervous damage Headaches
What are surgical complications?
Haemorrhage Trauma - bowel, bladder, uterus, fetus Infection - peritonitis, Pffanenstiel incision infection Thromboembolism (DVT/PE) Paralytic ileus
