C-section

Question 1

What are the risks of elective repeat Caesarian sections?

Answer 1

Morbidly Adherent placenta
Injury to bladder and bowel
Increased risk of hysterectomy

Question 2

What are signs of uterine rupture

Answer 2

Abnormal pain between contractions 
Fetal distress 
Diminished or altered uterine activity 
Alterations in fetal movement
Haematuria

Ctg may be the earliest sign of a rupture

Question 3

What are the factors associated with a successful VBAC?

Answer 3

Previous VBAC
Birth interval >2 years
Spontaneous labour
Estimated fetal weight

Question 4

What are the indications for a c section?

Answer 4

Maternal

• placenta Praevia (major)
• previous classical c section
• previous uterine surgery
• cervical carcinoma
• serious medical conditions
• bearing down efforts contraindicated ( cerebral aneurysm)
• uterine rupture
• previous vaginal repair or surgery for urinary incontinence

Fetal

• fetal distress
• prolapsed cord and live baby
• abruptio with live baby
• transverse lie
• brow or mento- posterior face presentation
• breech presentation
• multiple pregnancy
• macrosomia
• some congenital abnormalities

Combined:

• failure to progress
• failed forceps or vacuum
• failed induction of labour

Question 5

What are the types of Caesarian section?

Answer 5

Transverse lower uterine segment
Vertical lower uterine segment
Vertical upper uterine segment

Question 6

What are the indications for a classical c section

Answer 6

• absent or underdeveloped lower uterine segment
• inaccessible lower uterine segment (eg adherent bowel)
• transverse lie
• anterior placenta Praevia
• carcinoma cervix
• fibroids occupying the lower segment
• post Mortem c section

Question 7

What are the anaesthetic complications of a c section

Answer 7

High spinal
Failed intubation
Aspiration (particularly in pregnancy with delayed stomach emptying)
Atelectasis

Question 8

What are the surgical complications or pregnancy?

Answer 8

Haemorrhage
Trauma: bowel, bladder, ureter
Sepsis: endometritis, wound
Thromboembolism

Question 9

Contra indications to a VBAC

Answer 9

• previous classical c/ section
• 2 or more previous c sections
• patient refusal
• large baby
• malpresentation or other complication
• multiple pregnancy
• placenta Praevia

Question 10

When is an elective repeat Caesarian scheduled for?

Answer 10

38-39 weeks gestation

Question 11

What can be done if bleeding is uncontrolled during c-section?

Answer 11

• rub up uterus
• oxytocin infusion + 0.2mg Im ergometrine. Drugs can be given together.
• transfuse as necessary
• have assitant press over aorta untill cause found
• bleeding does stop? Perform uterine and uterine ivary artery ligation or hystorectomy

Question 12

What happens if baby is breech during c-section?

Answer 12

• grasp foot and deliver via incision

- complete delivery as vaginal breech(deliver legs body and arms and flex head using mauriceau smellie)

Question 13

What happens if baby is transverse?

Answer 13

If babys back is up(near top of uterus) - grasp ankles and pull through incision

If babys back is down?
High vertical uterine incision is needed, find feet and pull through incision.

Question 14

What are some post op care principles?

Answer 14

If bleeding ?

• massage uterus
• give oxy and ergo

If signs of infection and woman has a fever give anti bio until fever free for 48hrs

• ampicill 2g iv every 6hrs
• gentamicin 5mg/kg iv every 24hrs
• metronidazole 500mg iv every 8hrs