Maternal request CS

Question 1

RANZCOG statement

Answer 1

Basically give the woman a CS if she understands the risks
If you disagree - you have to believe serious harm or lack of understanding and refer to another colleague for second opinion

Question 2

What does CS improve?

Answer 2

Reduced UI but this effect reduces with time
No anal sphincter tear injury
Lower risk of HIE
Timing of delivery avoids risk of PD SB
Reduced erb’s palsy

Question 3

Complication risks from elCS, emCS, instrumental

Answer 3

7, 16, 12%

Question 4

Breast feeding risk for prelabour CS?

Answer 4

Difficult to study and adjust for confounding
Once initiated BF rates no different at 6months

Question 5

Subsequent pregnancy implications?

Answer 5

Placenta accreta - 0.24% after one, 6.7% after 6 CS
May be associated with IUGR, delayed conception, ectopics, SB >34 weeks, uterine rupture

Question 6

Complications of CS

Answer 6

TTN/RDS
Urinary tract injury 1 in 1000
2-7 in 100 injection post op
Uterine rupture 1/100-200
1-2 in 1000 emergency hysterectomy
Maternal death 1 in 4200 ( vs 1 in 25000)
Fetal skin lacerations 1-2 in 100
(no major change in childhood asthma or obesity)