Caesarean section

Question 1

Caesarean section
- Definition
- Features

Answer 1

Definition: baby is born through an incision in the abdominal wall and the uterus.

Features

• Emphasis on “quality survival” for the newborn

• Continuous fetal monitoring of heart rate increases the number of C-sections for fetal distress

• With advancing age of the mother there is a greater risk of having other medical problems, thus the C-section rate increases

• Decrease in the number of forceps deliveries, which in turn increases the number of C-sections

• Many obstetricians no longer wish to take the risk of a vaginal breech delivery

• Women with prior a C-section often choose or are required to have a repeat C-section

Question 2

Caesarean section
Types

Answer 2

1.Lower uterine segment operation

2. Upper uterine segment operation (“classical”) – less common!

Question 3

Indication C section maternal

Answer 3

1. Severe pre-eclampsia and HELLP syndrome
2. Previous C-section
3. Uterine or cervical tumors
4. HIV

Question 4

Indication C section Feto maternal

Answer 4

1. CPD
   2.Non-reassuring fetal status (fetal distress)
2. Abnormal progression of first or second stages of labor
3. Placenta previa
4. Placental abruption
5. Malpresentation
6. Cord presentation and prolapse

Question 5

C section classifications

Answer 5

1. Category 1 – urgent, immediate threat of life to mother or fetus
2. Category 2 – compromise is present but not immediate threat
3. Category 3 – no compromise but early delivery required
4. Category 4 – elective C-section

Question 6

C section complications

Answer 6

1. Dehiscence – especially in upper uterine segment
2. Bladder or ureter injury
3. Uterine atony → hemorrhage → shock
4. Infections
5. Bowels dysfunction
6. DVT and pulmonary embolus

Question 7

C section procedure steps

Answer 7

1. Skin disinfection to reduce risk of wound infection
2. A catheter is placed in the bladder and hair near the incision may be shaved
3. An incision is made in the skin and is carried through the abdominal wall to enter the pelvis. Skin incision may be made vertical or transverse (most common made 2-3 cm above pubic bone).

Decision is based on speed of entry, exposure needed, anticipated weight of the baby and risk of wound infection.

4. The uterus is then identified and incision is then carried into the uterus to allow for delivery of the baby.

Uterine incision can be either transverse (most common) or vertical. Some indications for a vertical incision in the uterus are a pre-term fetus, a fetus that is not head down and with emergency C-sections. Even in these situations a transverse incision may sometimes be used. A woman that has a prior C-section with a vertical uterine incision is usually not a candidate for vaginal birth

5. The fetal head or buttocks are then delivered through the uterine incision followed by the rest of the body.
6. Some obstetricians repair the uterus by first delivering the uterus through the abdominal incision and some repair it while it is still in the abdomen. The uterus is closed with one or two layers of suture
7. The layers of the abdominal wall are sutured and then the skin closed with either suture or staples

Question 8

Vaginal Birth After C-Section (VBAC)

Answer 8

1. After one C-section vaginal delivery is possible. After 2 C-sections vaginal delivery is not possible.
2. Clinically adequate pelvis (pelvis seems large enough based on exam)
3. Available anesthesia and personnel for emergency c-section
4. There is a higher success rate when the woman has had at least one vaginal birth in the past
5. Complications uterine dehiscence of old scar or uterine rupture.
6. If first pregnancy was C-section due to CPD than it is likely for second pregnancy to be done with C-section.

If first pregnancy was C-section due to macrosomia of the fetus than it is possible for second pregnancy to be done by vaginal delivery as the fetus might not be as large.