Caesarean Section

Question 1

Risk of emergency hysterectomy caesarean?

Answer 1

7-8 per 1000

Question 2

VTE risk caesarean

Answer 2

4-16 per 10,000 women

Question 3

bladder injury risk caesarean

Answer 3

1/1000

Question 4

ureteric injury risk at Caesarean

Answer 4

1/10,000

Question 5

death risk CS

Answer 5

1/12,000

Question 6

Risk of uterine rupture in future after one CS

Answer 6

2-7/1000

Question 7

Risk of stillbirth after previous CS

Answer 7

1-4/1000

Question 8

risk of placenta praevia and accreta with previous cs

Answer 8

4-8/1000

Question 9

Frequent maternal risks of LSCS

Answer 9

Pain 9/100
repeat CS 1/4
readmission 5/100
haemorrhage 5/1000
infection 6/100
fetal laceration 1-2/100

Question 10

Extra procedures which may become necessary during LSCS?

Answer 10

hysterectomy, blood transfusion, repair of damage to bowel, bladder or vessels.

Question 11

Three main fetal injuries at CS?

Answer 11

1. skull fracture or ICH following disimpaction
2. BPI following difficult shoulder delivery
3. Cervical spine, spinal cord and/or vertebral artery injury following delivery of after coming head in breech

Question 12

Additional risks when CS with fetal head deeply in pelvic?

Answer 12

fetal injury (skull #, ICH)
maternal injury: tears, haemorrhage, UTI

Question 13

Safety checks before fully dilated CS

Answer 13

1. senior VE immediately prior
2. steady, firm, upward pressure with cupped hand or insertion fetal pillow
3. experienced Obstetric/paeds attending or available if difficulty in delivery predicted
4. anaesthetics prepared for need to tocolyse or manage PPH

Question 14

If shoulder dystocia is encountered with delivery at CS, what can be done?

Answer 14

extend incisions to facilitate manoeuvres such as posterior arm delivery

convert uterine incision to T or J

Question 15

What can cause cervical spine/cord or vertebral artery injury in breech delivery?

Answer 15

hyperextension of the cervical spine with breech delivery.

Question 16

Preoperative safety considerations for caesarean breech delivery?

Answer 16

1. VE prior if in labour
2. flexion of head
3. large incisions
4. fundal pressure
5. mauriceau-smellie-veit manoeuvre
6. forceps
7. tocolysis
8. extension of uterine incision