Consent for CS, CS for praevia and instrumental

Question 1

How to provide information for informed consent?

Answer 1

Ahead of time
In appropriate language- Leaflets in various languages, Braille etc.
Use interpreters!

Question 2

What information to provide?

Answer 2

Any complication that the women would deem relevant (Montgomery)

Question 3

% of instrumental and EmCS

Answer 3

Instrumental- 1 in 8
EmCS- 1 in 5
P0- 1:2-3 instrument, 1:3 EmCS

Question 4

Information on risks

Answer 4

1/1-1/10- very common
1/10-1/100- common
1/100-1/1000- uncommon
1/1000-1/10 000- rare
Less than 1/10 000- very rare

Question 5

Instrumental consent

Answer 5

• Described the procedure
• Explain need for epis esp for forceps
• Explain risk of needing CS- esp if trial

Question 6

Benefits of instrumental

Answer 6

Expedite delivery- where fetal compromise is suspected
Relief for 2nd stage- if maternal exhaustion
Safer delivery- if medical conditions where mum shouldnt push

Question 7

Risks of instrumental

Answer 7

3rd/4th deg - 1-4% vaccum, 8-12% forceps
Tears 1:5-10
Epis- 5:10V, 9:10F

Fetal- IC haemorrhage, subgaleal/cephal haematoma, retinal haemorrhage, facial nerve palsy

PPH- 1-4:10 Very common
Forceps marks- very common
Cup mark on scalp- very common
Neonatal jaundice- 5-15:100
CS
Shoulder dystocia

Question 8

Praevia risks at CS (no prev CS)

Answer 8

Hysterectomy 11:100, very common
MOH 21:100
VTE 3:100
Bladder injury 6:100
Future praevia 23:100
Further lap 75:1000

Question 9

Preavia risk if prev CS

Answer 9

Hysterectomy 27:100 (11:100)

Question 10

Other procedures at praevia CS

Answer 10

Cell salvage
Repair of injuries- bowel, bladder, vessels
ITU admission
Blood transfusion
NNU admission