Caesarean Sections

Question 1

Give the 4 main acronyms associated with Caesarean sections

Answer 1

LSCS = lower segment caesarean section
EMCS = emergency caesarean section
ELCS = elective caesarean section
ERCS = elective repeat caesarean section

Question 2

Give the 4 categories

Answer 2

Cat 1 = EMCS (immediate threat to life)
Cat 2 = EMCS (maternal/foetal compromise that is not an immediate threat to life)
Cat 3 = Expedited CS (requires early delivery)
Cat 4 = ELCS

Question 3

Give 7 reasons for ELCS

Answer 3

1. Previous trauma (physical/emotional)
2. Previous CS
3. Placenta praevia
4. Breech presentation
5. Maternal health problems (e.g. heart condition)
6. Maternal request
7. Multiple pregnancy

Question 4

What needs to be done antenatally for ELCS?

Answer 4

• Pre-operative assessment
• Informed consent
• Obs (inc. urinalysis and weight)
• Bloods (FBS and G&S)
• Anaesthetic discussion and plan
• Discuss eating and drinking prior to procedure

Question 5

What needs to be done for intrapartum care for ELCS?

Answer 5

• Pre-operative medication (Ranitidine)
• Prep for theatre
• Catheterised
• Anaesthetic
• Skin prep and cleaned
• IV antibiotics

Question 6

What type of drug is ranitidine?

Answer 6

Antacid

Question 7

What staff are present for CS?

Answer 7

• Surgeons
• Anaesthetist
• Scrub nurses
• Receiving midwife
• Paediatrician/neonatal nurse
• ODP
• Partner

Question 8

Describe a classical incision

Answer 8

• Longitudinal cut
• Can be of the uterus, the skin or both
• Easier access to the baby but the scar is weaker as muscle are cut

Question 9

What are the layers that need to be incised?

Answer 9

• Skin
• Subcutaneous fat
• Rectus sheath (rectus abdominus muscle is parted)
• Abdominal peritoneum
• Pelvic peritoneum
• Uterus

Question 10

How is the baby delivered?

Answer 10

Surgeon delivers the baby whilst the surgeon’s assistant applies fundal pressure

Question 11

How is the wound closed?

Answer 11

• Uterus is closed in 2 layers

- Rectus sheath and skin sutured

Question 12

How often should recovery obs be done?

Answer 12

15 mins for 30 mins
30 mins for 2 hours
Hourly

Question 13

What postnatal care is required?

Answer 13

• Thromboprophylaxis
• Pain relief
• Bladder care
• Skin to skin encouraged
• BF support
• Wound assessment and care
• Pelvic floor exercises

Question 14

What are some of the risks associated with CS?

Answer 14

• Increased morbidity/mortality
• VTE
• Post-operative infection (wound, UTI, uterine, genital tract)
• Blood loss - anaemia
• Tiredness and pain