Caesarean Section

Question 1

Define C-section

Answer 1

A Caesarean section is the delivery of a baby through a surgical incision in the abdomen and uterus

Question 2

C-section indications

Answer 2

• Feotal breech position
• Multiple pregnancy
• Placenta praevia (low-lying placenta)
• GDM w/ feotal macrosomia
• Prev shoulder dystocia
• Prev 3rd/4th perineal tear
• Transmissible disease (poorly controlled HIV)

Question 3

Emergency Caesarean sections classifications

Answer 3

1 Immediate threat to the life of the woman or fetus
2 Maternal or fetal compromise that is not immediately life-threatening
3 No maternal or fetal compromise but needs early delivery
4 Elective – delivery timed to suit woman or staff

Question 4

C-section anaesthesia

Answer 4

Epidural - regional anaesthesia

Question 5

Which vertebral space is epidural injected into

Answer 5

L3 - L4

Question 6

What is the epidural space

Answer 6

a potential space located outside the dura mater, the outermost membrane surrounding the spinal cord and brain

Question 7

what is the est. blood loss during a c-section

Answer 7

500-1000ml

Question 8

C-section operative position

Answer 8

L lat. tilt of 15 degrees

Question 9

why is woman positioned at L lat. tilt during c-section

Answer 9

To avoid aortocaval compression (AKA supine hypotensive syndrome)

Question 10

Aortocaval compression pathophysiology

Answer 10

a condition that occurs during pregnancy when the weight of the gravid uterus compresses the aorta and inferior vena cava (IVC) against the spine. This compression can restrict venous blood return and leads to reduce CO to the mother and fetus.

Question 11

stat maternal C-section complications

Answer 11

• Postpartum haemorrhage (>1000ml)
• Wound haematoma
• Intra-abdominal haemorrhage
• Bladder/bowel trauma

Question 12

stat feotal C-section complications

Answer 12

• transient tachypnoea of the newborn
• fetal lacerations (1-2% risk, higher with previous membrane rupture)

Question 13

Late maternal C-section complications

Answer 13

• Urinary tract trauma (fistula)
• Subfertility (there is a delay in conceiving compared to women who have had vaginal deliveries)
• Regret and other negative psychological sequelae
• Rupture/dehiscence of scar at next labour (VBAC)
• Placenta praevia/accreta
• Caesarean scar ectopic pregnancy

Question 14

Intermediate C-section complications

Answer 14

Infection:
- urinary tract infection
- endometritis
- respiratory (higher risk if general anaesthetic used)

VTE

Question 15

C-section pre operative Ix

Answer 15

• FBC / Group & Save
• H2-receptor antagonist +/- prokinetics: to prevent Mendelson’s syndrome (aspiration of gastric contents)
• VTE prophylaxis: TEDs +/- LMWH

Question 16

what is given during c-section to aid placenta delivery

Answer 16

Oxytocin w/ controlled cord traction