Emergency Caeasrean Section

Question 1

2 types

Answer 1

Lower Segment Caesarean Section (99%)

Classic - longitudinal incision in upper uterus

Question 2

Indications

Answer 2

Absolute cephalopelvic disproportion
Placenta praevia
Pre-eclampsia
Post-maturity
IUGR
Fetal distress in labour / prolapsed cord
Failure of labour to progress
Malpresentation
Vaginal infection
Placental abruption (if fetal distress)
Cervical cancer

Question 3

Risks to mother

Answer 3

Serious - emergency hysterectomy, need for later surgery, admission to ICU, VTE, bladder injury, ureteric injury, death

Frequent - wound and abdominal discomfort for a few months, increased risk of needed caesareans during future pregnancies, bleeding, infection (wound, endometritis, UTI)

Question 4

Risks to fetus

Answer 4

Risk of uterine rupture in future pregnancies, stillbirth, placenta praevia, placenta accrete

Lacerations

Question 5

CI for VBAC

Answer 5

Majority of obstetricians would trial vaginal delivery

CI - previous uterine rupture, classical scar

Question 6

Operative Vaginal Delivery

Answer 6

More common in primiparous women, supine and lithotomy positions, epidural anaesthesia

Can be performed as long as the head is no more than 1/5th palpable in the abdomen and the leading point of the skull is not above the ischial spines

Question 7

Indications for operative vaginal delivery

Answer 7

Presumed fetal compromise
To shorten and reduce the effects of the 2nd stage of labour on medical conditions e.g. cardiac disease III or IV, HTN crises
Nulliparous - lack of continuing progress for 3 hours with regional anaesthesia or 2 hours without
Multiparous - lack of continuing progress for 2 hours with regional anaesthesia or 1 without
Maternal exhaustion

Question 8

Vacuum extractor

Answer 8

Should not be used at gestations of less than 34 weeks + 0 days
Use with caution between 34 + 0 and 36 + 0