Caesarean Sections

Question 1

What are the categories of CS?

Answer 1

1. EMCS (immediate threat to life)
2. EMCS (not immediately life threatening)
3. EXCS (requires early delivery)
4. ELCS

Question 2

Give some reasons for choosing an ELCS

Answer 2

• Previous trauma
• Previous CS
• Placenta praevia
• Breech
• Health problems (e.g. heart condition)
• Maternal request
• Multiple pregnancy

Question 3

What must be taken before a CS?

Answer 3

Antacid (e.g. Ranitidine, Omeprazole)

Question 4

What other preparations must be undertaken?

Answer 4

• Check for caps, crowns, loose teeth, dentures
• Shave
• Hospital gown
• Fast for 12 hours if possible
• Catheterise in theatre
• G&S in last 72 hrs

Question 5

What are the 2 types of incision?

Answer 5

1. Transverse

2. Classical (can be of the uterus or the skin or both)

Question 6

What are the pros and cons of a classical incision?

Answer 6

+ Easy access to baby (used for very high risk emergencies such as cardiac arrest)
- Scar is weaker

Question 7

Which layers need to be cut?

Answer 7

• Skin
• Subcutaneous fat
• Rectus sheath
• Abdominal peritoneum
• Uterus

Question 8

What is given intravenously during the operation?

Answer 8

• Antibiotics
• Oxytocin 5iu
• Fluids

Question 9

What observations need to be done post-operatively?

Answer 9

• 5 mins x 4
• 15 mins x 2
• 30 mins for 2 hrs
• 4 hourly

Question 10

What is a VBAC?

Answer 10

Vaginal Birth After Caesarean

Question 11

What is the antenatal management for VBAC?

Answer 11

• Refer to consultant
• Scan to confirm placental site
• Counselling

Question 12

What does having a VBAC reduce the risk of?

Answer 12

• RDS

- Complications in future pregnancies

Question 13

What is the intrapartum management for VBAC?

Answer 13

• IV access and bloods
• Raised awareness of scar tenderness
• Continuous CTG
• Bladder care

Question 14

What are the indicators for scar rupture?

Answer 14

• Abnormal CTG
• Severe, constant abdominal pain
• Scar tenderness
• Abnormal PV bleeding
• Cessation of contractions
• Signs of shock
  These are ALL obstetric emergencies

Question 15

What method of induction/augmentation has a lower risk of scar rupture?

Answer 15

Mechanical methods (e.g. ARM, foley catheter)

Question 16

What are the risks of IOL for VBAC?

Answer 16

• 2-3x risk of uterine rupture

- 1.5x risk of CS

Question 17

What happens if a pregnant woman had an extended incision in a previous CS?

Answer 17

She will be advised to have an ELCS as there is an increased risk of scar rupture

Question 18

What bloods are required prior to a CS?

Answer 18

FBC and G+S within the last 72 hours

Question 19

How long is the catheter left in after the surgery?

Answer 19

Min. 12 hours

Question 20

When are women usually encouraged get up after the surgery?

Answer 20

After 6 hours

Question 21

When should the scar dressings be changed?

Answer 21

Day 5 and 10 (off around day 14)