Cesarian Section Flashcards
OBS
Most significant operative intervention in obstetrics
Cesarian section
CS
Indications for CS
- Repeat CS
- Abnormal labour- dystocia
- Breech
- Fetal distress
- Placenta previa
- Umbilical cord prolapse
- Uterine rupture
- Malpresentation- brow
- Maternal conditions- severe pre- eclampsia
CS
Classifications of urgency to do a CS
Categories 1 to 4
CS
Category 1 of urgency to do a CS
Threat to life of mother or baby. Delivery is indicated** within 30 minutes. **
CS
Instances of category 1 urgency
- Uterine rupture
- severe prolonged bradycardia
- Cord prolapse
CS
Category 2 of urgency to do a CS
Maternal or fetal compromise not immediately life threatening. but as soon as possible consider other potential risks
CS
Category 3 of urgency to do a CS
No maternal or fetal compromise but early delivery is indicated.
CS
Category 4 of urgency to do a CS
Elective CA. timed suit to woman and patients
CS
Instances of category 2 urgency
- Ante- partum hemorrhage
- Non- progressive labor
CS
Instances of category 3 urgency
- Delivery is good within 75 minutes
- worsening IUGR and pre- eclampsia
CS
Steps in CS
- Incise the skin
- Incise the rectus
- Incise the peritoneum
- Seperate the visceral peritoneum
- Expose the uterus and incise the uterus
- Rupture the membranes
- Deliver the baby
- Deliver the placenta
- Identify the uterine incision
- Suture the uterine incision
- Close the rectus sheath
- Suture the skin- subcuticular
CS
Types of CS incisions of the uterus
- Lower segment uterine incision
- Classical uterine incision
CS
Lower segment uterine incision
Incised area is less vascular than other parts. Uterine closure is easier. Quick healing Reduced risk of rupture in the subsequent PG
CS
Classic uterine incision
- Chance of uterine rupture is high
- Rarely done unless absolute indications are present
CS
Absolute indications to do a classical uterine incision
- If the lower uterine segment has adhesions, fibroids
- CA in the cervix
- The baby is in transverse lie with the back down
- Placenta previa
- Conjoined twins
CS
Most commonly used uterine incision
Lower uterine segment transverse incision
CS
Anesthesia used
- Spinal
- Epidural
- General
CS
MC used anesthesia
spinal - Single shot, immediate relief, lasts 1-2 hours
CS
When is General anesthesia used
In situations where speed is required. in instances where regional anesthesia is contraindicated. In emergency situations
CS
Pre- op assessment
- Informed written consent
- Tests- FBC, Cross match 1 unit blood
- Antacid prophylaxis
- Anesthetist assessment
- catheterize
CS
Catheter is inserted in the….. position
15 degree left lateral position to reduce the risk of aorto- caval compression
CS
Three types of abdominal incisions
- Transverse curvilinear incision
- Transverse suprapubic incision
- Vertical skin incision
CS
Transverse curvilinear incision
2 finger breadths above the symphysis pubis
CS
Transverse suprapubic incision
- No curve
- Improved cosmetic results
- Reduced analgesics needed
- Better wound strength
CS
Vertical skin incision
- In obese mothers
- Suspicion of other intra- abdominal pathology
CS
What’s given to aid in uterine contractions and to expel the placenta
Syntocinon (IV)
CS
When is syntocinon given
once the fetus is delivered
CS
12 steps done post- op
4 THINGS TO MONITOR
* Monitor- vitals
* Monitor UOP
* Monitor QHT
* Monitor bleeding- PV bleeding
4 THINGS TO GIVE
* IV fluids - NS, Hartmanns until the pt starts feeding
* ABx- may continue sometimes
* DVT prophylaxis - enoxaparin
* Analgesics
4 THINGS TO DO
* Start feeding within 2H after uncomplicated delivery
* Remove the catheter when the pt is mobile without support
* Mobilization
* Wound care
CS
How often should you monitor vitals post- op
BP, RR , PR
* 1/4hourly for 2H
* 1/2hourly for 2H
* Hourly for 2H
CS
How often should you monitor UOP post- op
hourly
CS
DVT prophylaxis?
Most mothers are obese
PG is a hypercoagulable state
