C section

Question 1

indications for C/S

Answer 1

maternal

• previous C/S: complicated, not lower segment section, risk factor for C/S is still present
• pre-eclampsia
• GDM with other indication
• infection
• severe deterioration

antenatal

• IUGR or macrosomia
• placenta praevia
• severe antenatal haemorrhage
• sepsis
• chorioamnionitis

labour

• malpresentation
• cord presentation or prolapse
• obstructed labour
• foetal distress
• infection

Question 2

signs of uterine rupture

Answer 2

severe suprapubic pain
vaginal bleeding
reduced LOC
foetal and maternal distress

Question 3

benefits and risks of VBAC

Answer 3

benefits

• quicker recovery and shorter hospital stay
• avoid risks associated with C/S

risks

• uterine rupture
• normal VB risks
• conversion to unplanned C/S (higher risks than planned)
• requires tertiary centre care

Question 4

benefits, risks and alternatives for C/S

Answer 4

benefits

• individualised to patient
• reduces intrapartum risks to baby
• simple and effective
• planned date

risks

• spinal: reaction to anaesthetic, headache, hypotension, infection, neuro damage, bleeding
• GA: reaction, DVT/PE, MI/stroke, atelectasis/pneumonia
• specific: longer recovery, infection, haemorrhage, damage to nearby structures (ureter, bladder, bowel), foetal laceration, adhesions, resp distress in newborn, risks for future pregnancies

alternatives - vaginal delivery

• risks: tear, foetal risks (eg obstruction)
• benefits: avoid C/S risks, quicker recovery

Question 5

counselling for C/S

- before, during and after

Answer 5

before

• NBM, bloods
• spinal: needle into spine, pain free chest down
• epidural: if already in situ
• GA: for emergency, put to sleep

during

• cut just above pubic hair line
• cut into uterus
• retrieve baby
• check baby is ok
• skin to skin with mother
• close wound with stitches

after

• immediate: recovery, encourage breast feed, stay in hospital 3 days, anticoagulation, analgesia
• long term: 4-6 weeks to recover, rest, keep wound covered and clean
• practical: no heavy lifting, no sex, no driving, encourage to mobilise early, F/U with GP