Complications 1: Caesarean Birth & other complications

Question 1

Describe the indications for caesarean bith

Answer 1

plac previa / abruptio, prolapsed cord, CPD, active herpes, transverse lie, maternal health issues, failure to progress, breech, fetal distress, repeat c-sec

Question 2

Describe types, benefits and disdvantages of various skin and uterine incisions

Answer 2

Pfannenstiel (transverse)

• made across the lowest and narrowest part of the abdomen.
• almost invisible after healing.
• however does not allow for extension of the incision if needed.
• used if time is not of the essence

Kerr (transverse)
vertical lower segment

Advantage
-less blood loss
-moderate dissection of the bladder
-easier to repair, takes longer
-less likely to rupture during subsequent pregnancy
Disadvantage
-takes longer to make a transverse incision
-once a vertical incision is performed, future birth must be via cesarean

Classic incision

• more rupture
• more blood loss

Question 3

Discuss VBAC, care and treatment

Answer 3

frequent monitoring (fetal & maternal), EFM, VS, ?pain over incision site [rupture], caution with induction

Question 4

Discuss hemorrhage, care and treatment

Answer 4

the 4 T’s = TONE, TRAUMA, TISSUE, THROMBIN i.e., uterine atony, lacerations of genital tract, retained placenta or membranes, coagulation problems

Prevention #1: Avoid traumatic procedures & predict those who may hemorrhage (i.e. start IV, x-match). Active 3rd stage best practice!
Assess pt. frequently. Pt to void q2-3hrs.
RN to massage uterus, express clots, apply pressure prn, and give oxytoxic drugs IM / IV prn