CesareanDelivery

Question 1

What are the fetal indications for CS?

Answer 1

Abnormal presentation: BReech & transverse
Abnormal size: macrosomia
Abnormal number: multifetal pregnancy especially if malpresented

Abnormal fetus: congenital anomalies
Unhealthy fetus: non-reassuring status, cord prolapse and fetal distress, bradycardia, late deccelerations

Question 2

What are the maternal indications for CS?

Answer 2

Genital tract obstruction = tumor previa, excessive lower tract lesion that can bleed (condyloma, cervical caner, permanent coerciage)

Infections = HSV, HIV

Pelvic abnormality = small/deformed

Maternal conditions = cardiac, pulmonary, aneurysms, stroke

Concurrent patho = needs to be removed

Perimortem CS

Failed operative vaginal delivery

Question 3

What are the most common indications for CS?

Answer 3

1. Labor arrest
2. Non-reassuring fetal tracing
3. Malpresentation

Question 4

What are the diff uterine incisions?

Answer 4

Low transverse or Kerr (A)
Low vertical or Kronig (B)
Classical Incision (C)
J-incision (D)
T-incision (E)

Question 5

What is the most common & performed uterine incision in CS? Why?

Answer 5

Low transverse or Kerr (A)
- good healing, least bloody, easiest to repair

Question 6

What is the least preferred uterine incision in CS? What are its indication?

Answer 6

Classical incision
- more blood loss
- deliveries with anticipated difficulty in manipulation or when a bigger incision is required

Question 7

What uterine incicision has an incision extended vertically upwards?

Answer 7

J-incision (D)

Question 8

What type of uterine incision is used to make a vertical extension of the low transverse incision? where is the weakest point of this incision?

Answer 8

T-incision (E)

Weakest point: intersection betw transverse & vertical incision

Question 9

What is the most frequent abdominal incisions for CS?

Answer 9

Pfannenstiel incision and midline vertical incision

Question 10

What are the indications for Pfannenstiel incision?

Answer 10

Cosmetically appealing
Heals better
Less prone to dehiscence or hernia

Aka Primary low transverse cesarean section

Question 11

What are other necessary procedures can you do during cesarean section?

Answer 11

Removal of ovarian new growth
Tubal ligation or sterilization
Removal of myoma

Question 12

What is the most commonly used uterine incision repair?

Answer 12

Three-layer repair
1st layer: endo-myometrial
2nd layer: myometrium
3rd layer: serosa

Question 13

What is the AOG for recommended for CS on demand?

Answer 13

ACOG (2018) recommendation

NOT EARLIER THAN 39 WEEKS

Question 14

What are the diff intraoperative complications of CS?

Answer 14

Anesthesia accidents
Hemorrhage
Injury to pelvic and adjacent organs
Wound dehiscence

Question 15

What are the diff postapartum complications of CS?

Answer 15

Infections
Thromboembolism

Question 16

What are the future risks for CS?

Answer 16

Uterine dehiscence and rupture
Abruptio placenta
Placenta previa
Placenta accreta syndrome
Ectopic pregnancy
Intrapartum hemorrhage
Peripartum hysterectomy

Question 17

What are the prerequisites of vaginal birth after cesarean (VBAC)?

Answer 17

Only 1 previou cesarean delivery
Low transverse incision
Non-recurring indication for CS
No cephalopelvic disproportion
No other uterine scars or previous rupture
No maternal medical condition
Interpregnancy interval >18 months

Question 18

What condition occurs when there is through and through disruption of all uterine layers that can occur after VBAC?

Answer 18

Uterine rupture

Question 19

What is the earliest sign of uterine rupture?

Answer 19

Fetal tachycardia

Question 20

What are the signs & symptoms of uterine rupture?

Answer 20

Sudden tearing pain on abdomen
Hemorrhage: hypotension, tachycardia, pallor, vaginal bleeding

Fetus extruded out of uterus: fetal parts easily palpable abdominally, loss of station of presenting part

Fetal heart deceleration & bradycardia (lates sign) or tachycardia

Question 21

What is the separation of the previou cesaerean scar with the serosa of the uterus intact with absent hemorrhage & milder than uterine rupture?

Answer 21

Uterine dehiscence

Question 22

What is the removal of the uterus?

Answer 22

Hysterectomy

Question 23

what is the type of hysterectomy done at around the time of delivery?

Answer 23

Peripartum hysterectomy

Question 24

What is the type of hysterectomy where removal of uterus is in conjunction with a planned or unplanned Cesarean delivery?

Answer 24

Cesarean hysterectomy

Question 25

What is the removal of uterus done shortly after completion of vaginal or cesarean delivery?

Answer 25

Postpartum hysterecomy

Question 26

Why is peripartum hysterectomy comomnly done?

Answer 26

To control postpartum hemorrhage

Question 27

What are indications of peripartum hysterectomy?

Answer 27

Postpartum hemorrhage
Uterine rupture
Gynecological pathology
Uterine infection

Question 28

What are causes of postpartum hemorrhage?

Answer 28

Uterine atony
Uterine laceartions cannot be repaired
Placenta accreta
Placenta previa

Question 29

what is the most common cause of CS hysterectomy?

Answer 29

Placenta accreta

Question 30

What are the diff types of peripartum hysterectomy?

Answer 30

Total hysterectomy
Subtotal hysterectomy
Hysterectomy with bilateral salpingo-ooporectomy

Question 31

What type of peripartum hysterectomy is done in placenta previa/accreta?

Answer 31

Total hysterectomy
- removal of the uteirne corpus & cervix
- more blood loss bcs it is extensive

Question 32

What is the only part removed in subtotal hysterectomy?

Answer 32

Uterine corpuse is removed only

Question 33

What is the indication of Hysterecomy with bilateral salpingo-oophorectomy?

Answer 33

Ovarian new growth

Question 34

W