C-section

Question 1

What are the types of Caesarea section?

Answer 1

surgical procedure involving the delivery of a baby through an incision in the abdomen and uterus, performed under spinal anaesthesia, which includes:
*Classic
*Lower segment

Question 2

What is a classic C-section?

Answer 2

longitudinal incision in the upper segment of the uterus. This is the most common type as it is associated with less blood loss, fewer complications, and faster healing.

Question 3

What is a lower segment caesarean section?

Answer 3

horizontal (“bikini line”) incision in the lower, thinner part of the uterus to deliver a baby

Question 4

What are the absolute indications for Caesarean section?

Answer 4

cephalopelvic disproportion
Placenta praevia

Question 5

What are the indications for c-section?

Answer 5

*pre-eclampsia
*post-maturity
*IUGR
*fetal distress in labour/prolapsed cord
*failure of labour to progress
*malpresentations: brow
*placental abruption: only if fetal distress; if dead deliver vaginally
*vaginal infection e.g. active herpes
*cervical cancer (disseminates cancer cells)

Question 6

What is a category 1 C-section?

Answer 6

an immediate threat to the life of the mother or baby. delivery of the baby should occur within 30 minutes of making the decisio

Question 7

What are the indications for category 1 C-section?

Answer 7

*suspected uterine rupture
*major placental abruption
*cord prolapse
*fetal hypoxia
* persistent fetal bradycardia

Question 8

What is category 2 C-section?

Answer 8

maternal or fetal compromise which is not immediately life-threatening.

delivery of the baby should occur within 75 minutes of making the decision

Question 9

What is a category 3 C-section?

Answer 9

delivery is required, but mother and baby are stable

Question 10

What is a category 4 C-section?

Answer 10

Elective caesarean due to patient preference, or a non-acute concern that may cause challenging vaginal delivery but no foetal or maternal compromise

Question 11

What are the common maternal complications of C-section?

Answer 11

*persistent wound and abdominal discomfort in the first few months after surgery
*increased risk of repeat caesarean section when vaginal delivery attempted in subsequent pregnancies
*readmission to hospital
*haemorrhage
*infection (wound, endometritis, UTI)

Question 12

What are the common foetal complications of C-section?

Answer 12

Lacerations

Question 13

What are the serious complications of C-section to mother?

Answer 13

*emergency hysterectomy
*need for further surgery at a later date, including curettage (retained placental tissue)
*admission to intensive care unit
*thromboembolic disease
*bladder injury
*ureteric injury
*death

Question 14

How does C-section affect future pregnancy?

Answer 14

*increased risk of uterine rupture during subsequent pregnancies/deliveries
*increased risk of antepartum stillbirth
*increased risk in subsequent pregnancies of *placenta praevia and placenta accreta)

Question 15

How does C-section affect future birth planning?

Answer 15

Women with single previous C-section can do planned vaginal birth after C-section (VBAC) for pregnant women at over 37 weeks gestation. It has a 70-75% success rate

Question 16

What is a contraindication for C-section?

Answer 16

previous uterine rupture or classical caesarean scar

Question 17

What is a breech presentation?

Answer 17

positioning of the foetus in a longitudinal lie with the buttocks or feet proximal to the cervix and the head near the fundus.

Question 18

What are the types of breech presentation?

Answer 18

Frank breech
Footling breech

Question 19

What is frank breech?

Answer 19

A frank breech is the most common presentation with the hips flexed and knees fully extended

Question 20

What is a footling breech?

Answer 20

A footling breech, where one or both feet come first with the bottom at a higher position, is rare but carries a higher perinatal morbidity

Question 21

What are the risk factors for breech presentation?

Answer 21

*uterine malformations, fibroids
*placenta praevia
*polyhydramnios or oligohydramnios
*fetal abnormality (e.g. CNS malformation, *chromosomal disorders)
*prematurity (due to increased incidence earlier in gestation
* multiple gestation

Question 22

What is assoicated with breech presentation?

Answer 22

Cord prolapse

Question 24

When to intervene in breech presentation?

Answer 24

if still breech at 36 weeks NICE recommend external cephalic version

Question 25

When to offer intervention for breech in multiparous women?

Answer 25

37 weeks

Question 26

When to offer intervention for breech in nulliparous women?

Answer 26

36 weeks

Question 27

What are the absolute contraindications for external cephalon version?

Answer 27

*where caesarean delivery is required *antepartum haemorrhage within the last 7 days *abnormal cardiotocography *major uterine anomaly *ruptured membranes *multiple pregnancy

Question 28

How does external cephalon version work?

Answer 28

an obstetrician uses manual pressure on the mother’s abdomen to turn a breech (feet/bottom first) baby into a head-down position. ECV is usually carried out under ultrasound guidance and with careful CTG monitoring of uterine contractions and foetal heart rate. The mother is given analgesia and tocolytics during the procedure and, following the procedure, anti-D immunoglobulin

Question 29

What are the complications of ECV?

Answer 29

*Transient fetal heart rate changes *Placental abruption *Preterm labour *Premature rupture of membranes *Umbilical cord entanglement and compression *Foetal trauma

Question 30

What is foetal presentation?

Answer 30

Foetal presentation refers to the part of the foetus that lies closest to the cervix and will typically lead during labour and delivery

Question 31

What is the ideal foetal presentation?

Answer 31

Cephalic

Question 32

What is foetal lie?

Answer 32

Foetal lie' is the term which refers to the long axis of the foetus relative to the longitudinal axis of the uterus.

Question 33

What is the most common foetal lie?

Answer 33

Longitudinal

Question 34

What are the alternative foetal lie?

Answer 34

*transverse lie (<0.3% of foetuses at term) *oblique (<0.1% of foetuses at term

Question 35

What is transverse lie?

Answer 35

Sideways; the foetal head is on the lateral side of the pelvis and the buttocks are opposite. the foetus can be either 'scapulo-anterior' (most common) where the foetus faces towards the mother's back or 'scapulo-posterior' where the foetus faces towards the mothers front.

Question 36

Which lie are most foetus in during early gestation?

Answer 36

Transverse, but Most have moved to longitudinal lie by 32 weeks.

Question 37

What are the risk factors for abnormal lie?

Answer 37

*Most commonly occurs in women who have had previous pregnancies *Fibroids and other pelvic tumours *Pregnant with twins or triplets *Prematurity *Polyhydramnios Foetal abnormalities

Question 38

How is abnormal foetal lie diagnosed?

Answer 38

Abdominal examination: the head and buttocks are not palpable at each end of the uterus. The foetus can be felt to be lying directly across the uterus. Ultrasound scan: allows direct visualisation of the foetal lie. Foetal heart rate is also auscultated to assess for distress.

Question 39

What are the complications of abnromal foetal lie?

Answer 39

Pre-term rupture membranes (PROM) Cord-prolapse (20%)

Question 40

What happens with vaginal delivery in abnromal presentation?

Answer 40

Compound presentation with both arm and presenting part birth at the Same time

Question 41

When to intervene with abnromal lie?

Answer 41

After 36 weeks, with external cephalic version for all women who would like vaginal delivery

Question 42

What is a contraindication to external cephalon version?

Answer 42

maternal rupture in the last 7 days multiple pregnancy (except for the second twin) major uterine abnormality Success rate is around 50

Question 43

What position determines foetus lie?

Answer 43

*Uterine shape and size *Amniotic fluid volume *Foetal movements and growth

Question 44

What can occur with transverse lie?

Answer 44

Shoulder presentation

Question 45

What is used to determine foetus position in the womb?

Answer 45

Leopold manoeuvres with Clincial palpation of abdomen Auscultation of foetal heart rate Pelvic examination Ultrasound

Question 46

Which abnromal lie requires C-section?

Answer 46

Transverse or oblique lie

Question 47

What is the maximum tie external cephalon verdion can e done?

Answer 47

early labour, the membranes have not ruptured, and there are no signs of foetal distress or other contraindications

Question 48

What CTG finding indicates necessity of C-section?

Answer 48

the late decelerations which are a worrying sign especially in the context of foetal bradycardia, where instrumental delivery is not possible

Question 49

What are c sections associated with?

Answer 49

Placenta accreta

Question 50

What is a classic C section scar?

Answer 50

Vertical scar

Question 51

What determines baby position?

Answer 51

occiput (back of head) to pelvis

Question 52

What drug can be used to improve success rate of external cephalic version!

Answer 52

Terbutaline due to both its beta agonism mimetic effect inhibiting oxytocin which relax the uterus

Question 53

What placental emergency is associated with previous c sections?

Answer 53

Uterine rupture -> sudden onset of abdominal pain and loss of contractions during labour

Question 54

How often to take observations post c-section?

Answer 54

Every 30 minutes for the first 2 hours After this, adjust according to maternal stability

Question 55

What is frank breech?

Answer 55

legs are fully extended up to the shoulders and the presenting part is the buttocks

Question 56

What is footling breech?

Answer 56

one or both legs are fully extended towards the pelvic inlet, with the foot or feet being the presenting part

Question 57

What is complete breech?

Answer 57

the hips and knees are both flexed and the presenting part is the buttocks