C/S

Question 1

List 4 evidence based methods to reduce post op infection post C/S

Answer 1

• 2g IV cefazolin 30-60 mins prior to incision reduces SSI and endometritis
• skin prep with alcohol based solution (clorhexidine best) reduces SSI
• vaginal prep with iodine 10% for 30 seconds reduces endometritis, PP fever, and wound infection RR 0.5
• delivery of placenta by CCT rather than manual removal - reduces risk of endometritis and PP fever
• closing subcut layer if >2cm - reduces seroma and haematoma formation

Question 2

What is the evidence from Cochrane 2017 review regarding administration of steroids for PTB?

Answer 2

Reduced rates of:
- respiratory death RR 0.72
- respiratory distress syndrome RR 0.66
- IVH RR 0.55
- NEC RR 0.50
- need for mechanical ventilation RR 0.68
- systemic infection in the first 48 hrs of life RR 0.6

Question 3

What are the ‘no difference’ effect of steroid for PTB?

Answer 3

no difference in:
- chronic lung disease
- mean birthweight
- death in childhood or adulthood
- neurodevelopment
- chorioamnionitis/endometritis