Cesarean section

Question 1

What is a CS section defined as with reference?

Answer 1

‘an operative procedure which is carried out under anaesthesia (regional or general), whereby the fetus, placenta and membranes are delivered through an incision made in the abdominal wall and uterus’

(Hayman, 2015)

Question 2

between 2015-2016 how many births were CS sections (in percentage)

Answer 2

27% if total births

Question 3

Define Category 1 CS section

with ref

Answer 3

Immediate threat to life of the woman or fetus

NICE, 2011

Question 4

Define Category 2 CS section

with ref

Answer 4

Maternal or fetal compromise which is not immediately life threatening

Question 5

Define Category 3 CS section

with ref

Answer 5

No maternal or fetal compromise but needs early delivery

NICE,2011

Question 6

Define Category 4 CS section

with ref

Answer 6

Delivery timed to suit woman or staff

NICE,2011

Question 7

How long should the interval be when making a decision to do EMCS?

Answer 7

• Category 1: 30 minutes

* Category 2: up to 75 minute

Question 8

Name the things done to prepare a woman for EMCS ?

Answer 8

• Discussion and informed consent – involve partner
• Documentation
• Bloods taken for FBC, G & S ( X match if necessary) (if time)
• Anaesthetic discussion and plan (antacid)
• Antibiotic prophylaxis
• Prepare for theatre (pubic hair prep, jewellery removal, name band, gown, transfer to theatre, catheterise, ?partner in gown)-Skin cleaned and prepare

Question 9

What staff are present in an EMCS?

Answer 9

• Surgeons
• Anaethetist
• Scrub nurse/midwife
• Receiving midwife
• paediatrician/ANNP/neonatal nurse
• ODP/theatre nurse
• Partner (?)

Question 10

What procedure is done during EMCS?

Answer 10

• Incision - usually transverse lower segment
• Layers that need to be incised: skin, subcutaneous fat, rectus sheath, (rectus abdominus (muscle) is parted), abdominal peritoneum, uterus (muscle)
• The peritoneum above the bladder is incised and the bladder moved out of the way (reflected down)
• The uterine muscle should be incised carefully to avoid trauma to the fetus (NB amniotic fluid)
• The surgeon then delivers the baby whilst the surgeon’s assistant applies fundal pressure
• Cord then clamped and cut
• Baby passed to receiving midwife and taken to resuscitaire
• Neonatal resuscitation may be required
• Skin to skin encouraged in theatre if appropriate
• Oxytocin IV (5iu) (NICE 2011)
• Placenta and membranes delivered by CCT
• Uterus closed in 2 layers, rectus sheath and skin sutured
• Wound dressed
• Vagina swabbed to remove clot

Question 11

What Neonatal Care will be given to the Neonate after the EMCS?

Answer 11

• Resuscitation may be needed
• Paediatrician should be present at delivery
• Umbilical artery blood pH should be taken if suspected fetal compromise
• Keep baby warm!
• Skin to skin if appropriat

Question 12

What postnatal care would you provide t both the mother and the neonate?

Answer 12

• Post operative recovery observations (BP, P, R, T, wound, lochia, pain) 15 mins for 30 mins, then 30 mins for 2 hours, hourly then 4 hourly
• Thromboprophylaxis (NICE 2011)
• Pain relief
• Bladder care - catheter removal
• Skin to skin encouraged
• Breastfeeding support
• Wound assessment and care (NB. may also have perineal wound)
• Postnatal exercises and PFE encouraged
• DEBRIEF (provide verbal and written information NICE 2011)

Question 13

What risks are associated with CS section?

Answer 13

• Increased morbidity/mortality
• Increased risk of post-operative infection (wound, UTI, uterine, genital tract)
• Increased blood loss, increased risk postnatal anaemia
• Tiredness
• Pain
• Psychological support