Intrapartum Care - Caesarean Section

Question 1

What is a Caesarean Section?

Answer 1

Surgical operation to deliver the baby via an abdominal and uterine incision.

Question 2

Types of Caesarean Section (2).

Answer 2

1. Elective - Planned Procedure.

2. Acutely during Antenatal Period/Labour - Emergency.

Question 3

Process of Elective Caesarean Section.

Answer 3

Planned date, performed under spinal anaesthesia (usually after week 39).

Question 4

Indications of Elective Caesarean section (10).

Answer 4

1. Previous C-Section.
2. Symptomatic after Previous Significant Perineal Tear.
3. Placenta/Vasa Praevia.
4. Breech Presentation.
5. Multiple Pregnancy.
6. Uncontrolled HIV Infection.
7. Cervical Cancer.
8. Antenatal Issues : IUGR, PET.
9. Vaginal Infection e.g. Active Herpes.
10. Foetal Distress : In Labour, Prolapsed Cord, Placental Abruption.

Question 5

What anaesthesia is used in C-Sections?

Answer 5

Spinal - local anaesthetic injection at lower back to block nerves from abdomen downwards.

Question 6

Risks of Anaesthesia.

Answer 6

1. Allergy/Anaphylaxis.
2. Hypotension.
3. Headache.
4. Urinary Retention.

Question 7

Risks of General Anaesthesia (2).

Answer 7

1. Sore Throat.

2. Damage to Teeth/Mouth.

Question 8

Risks of Spinal Anaesthesia (2).

Answer 8

1. Nerve Damage.

2. Haematoma.

Question 9

Categories of Emergency C-Section (4).

Answer 9

1. Immediate Threat to Life of Foetus/Mother : Decision to Delivery Time : 30 Minutes e.g. uterine rupture, major placental abruption, cord prolapse, foetal hypoxia, persistent foetal bradycardia.
2. Urgent due to Compromise (no imminent threat) : Decision to Delivery Time : 75 Minutes.
3. Required but Stable.
4. Elective.

Question 10

Procedure of C-Sections.

Answer 10

Commonest Skin Incision : Transverse Lower Uterine Segment Incision.

Question 11

Types of Transverse Lower Uterine Segment Incisions (2).

Answer 11

1. Pfannenstiel : Curved Incision Two Fingers Width Above Pubic Symphysis.
2. Joel-Cohen : Straight Incision Slightly Higher (recommended).

Question 12

When are Vertical Incisions indicated? (2)

Answer 12

1. Very premature deliveries.

2. Anterior Placenta Praevia.

Question 13

What is Blunt Dissection?

Answer 13

Separation of remaining layers of abdomen with fingers - less bleeding, shorter operating time, less injury risk.

Question 14

Layers of Dissection.

Answer 14

1. Skin.
2. SC Tissue.
3. Fascia/Rectus Sheath.
4. Rectus Abdominis Muscles.
5. Peritoneum.
6. Vesicouterine Peritoneum & Bladder.
7. Uterus.
8. Amniotic Sac.

Question 15

How is the Uterus closed?

Answer 15

Two layers of sutures - avoid exteriorisation.

Question 16

Risk Reduction in C-Section.

Answer 16

1. H2 Receptor Antagonists or PPIs before Procedure (Aspiration Pneumonia Risk).
2. Prophylactic Antibiotics.
3. Oxytocin (PPH Risk).
4. VTE with LMWH.

Question 17

General Surgical Risks of C-Section (4).

Answer 17

1. Bleeding.
2. Infection.
3. Pain.
4. VTE.
5. Injury to Surrounding Structures e.g. Bladder, Urethra.
6. EMERGENCY HYSTERECTOMY.

Question 18

Complications of C-Section in Postpartum Period (4).

Answer 18

1. PPH.
2. Wound Infection.
3. Wound Dehiscence.
4. Endometritis.

Question 19

Effects of C-Section on Future Pregnancies (4).

Answer 19

Increased Risk of :

1. Repeat Caesarean.
2. Uterine Rupture.
3. Placenta Praevia.
4. Stillbirth.

Question 20

What is VBAC?

Answer 20

Vaginal Birth after Previous Caesarean.

Question 21

Contraindications to VBAC (3).

Answer 21

1. Previous uterine Rupture.
2. Vertical Incision.
3. Usual Contraindications to Vaginal Delivery.

Question 22

VTE Prophylaxis (3).

Answer 22

1. Early Mobilisation.
2. Anti Embolism Stockings/Intermittent Pneumatic Compression of Legs.
3. LMWH e.g. Enoxaparin.