C section

Question 1

Foetus reasons for c section

Answer 1

• breech at 36w (with failed external cephalic version)

- twins

Question 2

Placenta reasons for c section

Answer 2

• placenta previa

- morbidly adherent placenta

Question 3

Maternal infection reasons for c section

Answer 3

• co-infection of Hep C + HIV (not either of these infx alone)
• primary HSV infection in 3rd trimester

Question 4

Labour reasons for c section

Answer 4

• presumed foetal compromise

- failure to progress in labour

Question 5

Contraindications to external cephalic version for breech babies

Answer 5

i. In labour
ii. Uterine scar or abnormality
iii. Foetal compromise
iv. Ruptured membranes
v. Vaginal bleeding
vi. Medical conditions eg CVS, renal

Question 6

What is the ideal minimum gestational age for an elective C section? Why?

Answer 6

39 weeks

To reduce risk of respiratory morbidity

Question 7

List categories 1-4 of C sections

Answer 7

1. Immediate threat to life of mum/ baby (operate within 30min)
2. Mum/baby compromised but not immediately life-threatening (operate within 75min)
3. No compromise to mum/baby but need early delivery
4. Elective delivery

Question 8

Maternal complications of C sections

Answer 8

• Haemorrhage
• Need for blood transfusion
• Infection of uterus or wound
• Visceral problems eg bladder/ bowel damage
• Post-operative pain & immobility
• VTE

Question 9

Foetal complications of C sections

Answer 9

• Increased risk of foetal respiratory morbidity
• Foetal lacerations (rare)
• Increased rates of obesity & diabetes

Question 10

Complications of C sections for subsequent pregnancies

Answer 10

• increased risk of placenta previa

- placenta may implant more deeply than normal (may need emergency hysterectomy)