Caesarean section

Question 1

Caesarean section - classification (2)

Answer 1

1. Elective = planned before onset of labour

2. Emergency = once labour has been dx

Question 2

Caesarean section - indications

Answer 2

Emergency

1. Placental abruption with abnormal FHR or uterine irritability
2. Cord prolapse
3. Scar rupture
4. Prolonged bradycardia
5. Failure to progress with pathological CTG

Elective

1. Placenta previa
2. Previous CS (esp. classical)
3. Maternal HIV, or primary genital herpes in 3rd trimester
4. Term singleton breech (if ECV contraindicated or failed)
5. Severe pre-eclampsia, or IUGR with poor fetal function tests

Question 3

Caesarean section - complications

Answer 3

Intraoperative

1. Uterine/uterocervical lacerations
2. Blood loss >1L
3. Bladder laceration/bowel lacerations
4. Blood transfusion
5. Hysterectomy

Postoperative

1. Endometritis
2. Wound infections
3. Pulmonary atelectasis
4. VTE
5. UTI

Long-term effects (in subsequent pregnancies)

1. Uterine rupture
2. Placenta previa
3. Placenta accreta
4. Antepartum stillbirth
5. Adhesions