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Pathologic Obstetrics > CS and Hysterectomy > Flashcards

CS and Hysterectomy Flashcards

1
Q

Surgical procedure where in one or more incisions are made through a mother’s abdomen and uterus to deliver one or more fetus, or rarely, to remove a dead fetus

A

Cesarean delivery

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2
Q

2 techniques employed in CS

A

Laparotomy- Abdomen

Hysterotomy- Uterine wall

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3
Q

True/ False

Cesarean section and removal of fetus in Uterine rupture or abdominal surgery is the same

A

False

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4
Q

What is PERImortem CS?

A

performed in a woman about to die

for emergent complications like intractable hemorrhage

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5
Q

What is POSTmortem CS?

A

performed in a woman after death

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6
Q

Compare Cesarean Hysterectomy vs. Postpartum Hysterectomy

A

CH- at the time of CS

PH- after vaginal delivery

basta pag postpartum hysterectomy, nag vaginal delivery na saka pa lang hysterectomy, pag cesarean hysterectomy naman sabay na after CS the proceed to hysterectomy

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7
Q

4 major reasons for CS to be perfomed

A

Prior CS
Dystocia
Fetal Distress
Abnormal Fetal Presentation

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8
Q

12 explanation for increasing CS rates

A
  1. Increasing number of nulliparas
  2. Increasing maternal age
  3. Increased availability and utilization of electronic fetal monitoring
  4. Breech presentation
  5. Increased decline to perform operative VD
  6. Increased rates of labor induction
  7. Increasing number of obesity
  8. Increasing rates of preeclampsia
  9. Repeat CS is now the norm
  10. Increasing maternal request (pelvic floor injury concern and fetal injury concern in VD)
  11. Increasing use of assisted reproductive technology
  12. Increased number of malpractice litigation
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9
Q

What is CDMR

A

Cesarean delivery on maternal request

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10
Q

4 Major reason for CDMR

A

Pelvic floor protection
Convenience
Fear of childbirth
Reduced risk of fetal injury

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11
Q

Recommendation of ACOG in performing CDMR

A

Established fetal lung maturity (usually at 39 weeks)

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12
Q

True or False?
Cesarean delivery is ideally avoided in women desiring several children because of placental implantation abnormalities and cesarean hysterectomy risks

A

True

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13
Q

True or False?

CDMR should be motivated by the unavailability of effective pain management.

A

False (should not be motivated)

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14
Q

3 PRINCIPAL MATERNAL risk after CS

A

Infection
Hemorrhage
Thromboembolism

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15
Q

Give 6 complications of CS

A
  1. Anesthetic complications
  2. Adjacent organ injuries ( bladder, ureters, bowel)
  3. Repeat CS with future pregnancy
  4. Infection
  5. Hemorrhage
  6. Thromboembolism
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16
Q

Give 3 complication that is higher in VD compared to CS

A

Pelvic floor injury
Urinary incontinence
Perineal injury

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17
Q

True or false?

Anal incontinence is higher in Vaginal delivery

A

False (Anal incontinence risk is the same for VD and CS)

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18
Q

What is the most common Neonatal morbidity in CS?

A

Skin laceration

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19
Q

True or false?

Cesarean delivery is associated with a higher rate of fetal trauma

A

False (Lower rate than VD)

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20
Q

Give 6 NEONATAL complication of CS

A 
Skin laceration 
Cephalohematoma
Clavicular fracture
Brachial plexopathy
Skull fracture
Facial nerve palsy
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21
Q

What circumstance gives the HIGHEST neonatal injury rate in CS?

A

Failed operative vaginal delivery

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22
Q

What circumstance gives the LOWEST neonatal injury rate in CS?

A

If done elective

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23
Q

True/ False?

Offspring with Asthma and Allergy is linked to being born cesarean

A

True

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24
Q

What are the 6 patient preparation before performing CS?

A
  1. Delivery availability
  2. Informed Consent
  3. Timing/ Scheduling
  4. Perioperative care
  5. Infection prevention
  6. Surgical Safety
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25
Q

What principle is being valued when seeking Informed consent”?

A

Autonomy

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26
Q

True/ False?

For women with a prior cesarean delivery, the option of a trial of labor should be included for suitable candidates

A

True

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27
Q

True/ False?
In those women desiring permanent sterilization or intrauterine device insertion, consenting for these can be completed concurrently

A

True

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28
Q

True or False?

ACOG recommend delaying nonmedically indicated deliveries until 39 completed weeks of gestation or beyond

A

True

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29
Q

What are the 3 criteria used for accurate gestational age dating?

A
  1. Sonography
  2. Fetal heart sound
  3. B-hcg
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30
Q

In dating gestational age, when is sonographic measurements taken?

A

Before 20 weeks

31
Q

In dating gestational age, what is the duration for documenting Fetal Heart Sound?

A

Documented for at least 30 weeks

32
Q

In dating gestational age, what is the duration for documenting B-HCG positivity?

A

Documented for at least 36 weeks

33
Q

When is sedative being given as part of perioperative care?

A

Bedtime the night before surgery

34
Q

At least how many hours of fasting is required before CS?

A

6-8 hours

35
Q

At least how many hours does the patient may take CLEAR fluid before CS?

A

2 hours before

36
Q

What are the goal and protocols of ERAS (Enhanced Recovery after surgery)?

A

Goal: Strive to maintain anabolic homeostasis

Protocol:

  1. Advocate clear carbohydrate drink up to 2 hours before surgery
  2. Early post operative feeding.
37
Q

What should be done to reduce risk of gastric aspiration in CS?

A

Administer antacid before REGIONAL anesthesia or use general anethesia

38
Q

In what way does wedge beneath the right hip and lower back creating a lateral tilt can help?

A

Aid venous return

Avoid hypotension

39
Q

What is the protocol for hair removal during CS?

A

Clipping, not shaving
Done the day of CS
(Fewer surgical site infections)

40
Q

Where is electro-grounding pad usually placed?

A

Lateral thigh

41
Q

3 reasons why indwelling catheter should be inserted

A
  1. to collapse the bladder away from incision
  2. Prevent urinary retention in regional anesthesia
  3. Allow post-op urine measurement
42
Q

How to prevent Venous thrombosis?

A
  1. Initiate thomboprophylaxis

2. Initiate pneumatic compression hose before CS and discontinued when woman abulates

43
Q

What kind of wound is CS delivery?

A

Clean Contaminated wound

44
Q

What is the cost effective Antibiotic of choice for infection prevention?

A

Cefazolin 1g/dose

45
Q

What are the usual prophylactic antibiotics given in CS delivery?

A

IV route– B lactam antibiotic either Cephalosporins or Extended spectrum Penicillins

46
Q

In what condition does the physician add another dose of antibiotics?

A
  1. Blood loss >1500 mL

2. Three hours duration of surgery

47
Q

How many dose or antibiotic is usually given in CS?

A

1 dose

48
Q

What are the different laparotomy incisions?

A

Transverse and Vertical

49
Q

What do you call the transverse laparotomy insicion?

A

Pfannenstiel or Maylard incision

50
Q

When would you do a Pfannensteil Incision?

A
  1. For cosmetic purpose

2. To lower incisional hernia rates

51
Q

When would you not do a Pfannensteil Incision?

A
  1. When large operating space is essential
  2. When access to the upper abdomen is needed
  3. When risk for infection is high
  4. When reducing risk of bleeding, wound hematoma and neurological disruption
52
Q

Why is Transverse laparotomy incision not done if there is high risk of infection?

A

Because of the layers created during incision of the internal and external oblique aponeuroses, purulent fluid can collect between these.

53
Q

Why is transverse laparotomy incision superior in cosmesis?

A
  1. Because it follows the langer lines of the skin tension

2. Incision can be covered “bikini cut”

54
Q

For repeat CS, which laparotomy incision has more faster reentry?

A

Vertical

55
Q

Why is Transverse laparotomy incision more time consuming and difficult for reentry?

A

Because of scarring

56
Q

When would you do a a vertical laparotomy Incision?

A
  1. When minimizing blood loss
  2. When needing access to the upper abdomen
  3. When extending or larger space is needed.
  4. When better visualization of the uterus is needed
  5. If you need less operative time
57
Q

When would you not do a a vertical laparotomy Incision?

A
  1. If cosmesis is a concern

2. When reducing risk of fascial dehiscence and incisional hernia

58
Q

In transverse laparotomy incision, cut is made where?

A

UPPER BORDER: At the level of pubic hairline (3 cm above superior border of symphysis pubis

LATERAL BORDERS: Rectus abdominis muscles

59
Q

What is the adequate width of transverse laparotomy incision to accommodate delivery?

A

12-15 cm

60
Q

What vessel is usually identified halfway between the skin and facia several cm from the midline that should be coagulated

A

Superficial epigastric Vessel

61
Q

What are the 2 visible layers of anterior abdominal fascia?

A
  1. Aponeurosis of external oblique

2. Aponeurosis of internal oblique and transverse abdominis muscle (fused)

62
Q

What is the importance of incising individually the 2 layers of anterior abdominal fascia?

A

To spare the INFERIOR EPIGASTRIC VESSEL

It usually lie outside the lateral border of rectus abdominis muscle and beneath the fused aponeuroses

63
Q

What is the name of the clamp used to grasp the inferior fascial edge once fascia was incised?

A

Kocher Clamp

64
Q

Why is fascial separation is carried near enough to the umbilicus?

A

To permit adequate midline longitudinal peritoneal incision.

65
Q

What is being exposed when separating the rectus abdominis and pyramidalis muscles in the midline?

A

Transversalis fascia and peritoneum

66
Q

For midline laparotomy vertical incision, cut is made where?

A

2-3 cm above the superior margin of the symphysis up to the infraumbilical area

Incision length should
correspond to estimated fetal size, approximately
12-15 cm

67
Q

How is accidental cystotomy prevented?

A

Small opening is made sharply with scalpel in the upper half of the linea alba

68
Q

What are the different hysterotomy incisions?

A

Low transverse
Classical
Low segment vertical

69
Q

Advantage of low transverse hysterotomy incision

A

✓ Easier to repair
✓ Located at a site least likely to rupture during a subsequent pregnancy
✓ Does not promote adherence of bowel or omentum to the incisional line

70
Q

Classical incision uses vertical or transverse insicion?

A

Vertical

71
Q

Indication of Classical Hysterotomy incision

A

If the LUS cannot be exposed or entered safely because of:
1. Bladder adherent densely from the previous surgery
2. Myoma in the lower uterine segment
3. Invasive cancer of the cervix
4. Large fetus in the transverse lie (dorsoanterior or backdown)
5. Placenta previa with anterior implantation
6. Very small fetuses in breech with LUS knot
7. Massive maternal obesity where upper uterus is easily
accessible

72
Q

Vertical incision at the lower uterine segment

A

Low segment vertical incision

73
Q

A vertical incision into the body of the uterus above the lower uterine segment and reaches the uterine fundus

A

Classical incision

74
Q

Lower uterine segment is incised transversely

A

Low transverse incision

Pathologic Obstetrics (3 decks)

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