MRCOG - Part 2 > Cesarean Section > Flashcards

Cesarean Section Flashcards

(67 cards)

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1
Q

Rate of adhesions at umbilicus after midline incision?

A

55%

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2
Q

Rate of adhesions at umbilicus after low transverse incision?

A

23%

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3
Q

Do we need to do bladder dissection in case of classical cs

A

No

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4
Q

A subsequent trial of labour is allowed for women with previous classical caesarean section?

A

No it’s contraindicated due to risk of uterine rupture

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5
Q

rate of bladder injuries that need repair

A

1-1000

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6
Q

Rate of CS deliveries

A

25%
15% emergency
10% elective

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7
Q

Most common causes of unplanned CS

A

Labor dystochia
Fetal hypoxia
Malpresentation

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8
Q

When HIV is an indication of CS

A

VL<50: vaginal - VBAC
VL 50-399: consider CS
VL>400: CS

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9
Q

Timing of CS in HIV pts

A

If bec. Prevention of vertical transmission: 38-39w
If bec. Of obs indications: >39w

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10
Q

If women requested CS d.t. Tokophobia

A

Refer to psychomental health

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11
Q

ECV should be offered for breech except

A
  • in labour
  • uterine scar or abnormalities
  • fetal compromise
  • ROM
  • vaginal bleeding
  • medical conditions
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12
Q

When to offer ECV in breech

A

36 w

If unsuccessful, declined orCI, offer CS

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13
Q

When to perform CS in multiple pregnancy

A

If the first not cephalic
MA
Triplets

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14
Q

CS indications in SGA

A
  • Abnormal DV
  • poor STV in cCTG
  • AREDV
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15
Q

Do CS reduces risk of vertical transmission in women with hepatitis C

A

No
Offer CS IF: hepatitis C+ HIV

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16
Q

When to offer CS for HSV

A

In primary genital HSV in the 3rd trimester

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17
Q

Management of 1ry genital HSV IN 3rd trimester

A

Consider acyclovir 400 mg TDS until delivery
- planned CS

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18
Q

Do a BMI>50 alone an indication for CS

A

No

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18
Q

Timing of planned CS

A

Not before 39 w to reduce neonatal respiratory distress

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19
Q

Surgical site infection prevention

A
  1. Alcohol based chlorhexidine
  2. Alcohol based iodine
  3. AB before insicion (not coamoxiclav)
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20
Q

Best CS Incision

A

Joel cohen (3cm above SP)

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21
Q

Methods to assist cs in fully dilated women

A
  • push method
  • pull method (reverse breech extraction)
  • patwardhan’s method
  • fetal pillow
  • C-snorkel
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22
Q

When do we routinely close subcutaneous tissue

A

If more than 2 cm

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23
Q

Indications of myomectomy with CS

A
  1. Fibroids causing difficulty with closure of the uterine incision
  2. to facilitate safe delivery of the fetus
  3. large fibroids greater than 6 cm in diameter
  4. visible subserosal fibroids
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24
FINAL DECISION FOR VBAC should be made by what age
36 w
25
VBAC Success rate
75%
26
VBAC Success rates
Overall: 75% Pvs vaginal delivery: 90% Pvs cs dt fetal malpresentation: 84% Pvs cs for fetal distress: 73% Pvs cs for labor dystocia: 64% Multiple risk factors: 40%
27
Risk of rupture uterus with VBAC
1/200
28
When neonatologist should be present in CS
1- cs perfromed under GA 2- where there is evidence of fetal compromise
29
Observation after recovery of anasthesia of cs
Rr,hr,bp every half hour for 2 hours and hourly after
30
Post cs monitoring of women with interthecal or epidural morphine or diamorphine
If + RF for respiratory depression: hourly o2 ,RR for 12 hours the local protocols If no Rf: local protocol
31
When double drain is indicated after CS
If the patient receiving therapeutic LMWH
32
What type of analgesics avoided in breastfeeding
Avoid codeine and co-codamol as it can cause serious neonatal sedation and respiratory depression Give dihydrocodeine tartrate
33
When to remove urinary catheter
-After spinal: once woman is mobile -Not sooner tahn 12 hrs After last epidural dose
34
Contraindications of VBAC
Pvs Rupture uterus Pvs classical CS
36
Most significant sign of rupture uterus
Loss of station of the presenting part Abnormal CTG
37
Classic triad pf complete uterine rupture
1. Vaginal bleeding 2. Pain 3. Fetal HR Abnormalities
38
Rate of stress incontinence after CS
4%
39
Rate of fetal injury after CS
2%
40
Rate of blood transfusion after cs
1.7%
41
Risk of emergency hysterectomy with elective cs
0.2%
42
CS categories
CAT1: within 30 mins CAT2: within 75 mins CAT3: wait for steroids CAT4: elective CS
43
Most commonly used anasthesia for CS in UK
Spinal + intrathecal diamorphine
44
Which opioid is recommfor usewith regional analgesia in CS
intrathecal diamorphine
45
Recommended med to use in active management of 3rd stage during CS
Oxytocin 5 IU IV
46
Risk of rupture uterus in VBAC in pt with pvs uterine rupture
5%
47
Risk of rupture uterus in VBAC in pt with pvs classical repair
2-9%
48
Risk of rupture uterus with VBAC
1/200 0.5%
49
The best imaging modality to assess isthmocele
Gel infusion sonography
50
1st line diagnostic tool for isthmocele
TVUS
51
Proportion of women with pvs CS develop an isthmocele
50%
52
How isthmocele be managed when the residual myometrial thickness <3mm
Laparoscopic excision and repair +- shortening of round ligament
53
How isthmocele be managed when the residual myometrial thickness >3mm
Hysteroscopic trimming of lower edge +- ball cauterization of bed
54
Underlying pathophyiology of Ogilive syndrome
Parasympathetic injury and sympathetic predominance
55
Widest part of the colon which is susceptible to rupture during ogilivie syn
Cecum
56
What is the most characteristic clinical finding in Ogilvie syndrome?
Abdominal distension
57
What is the most useful diagnostic test for Ogilvie syndrome?
Plain abdominal x-ray
58
What are the first-line step after blood investigations and an abdominal X-ray indicate (Acute colonic pseudo obstruction)
Seek surgical review Conservative TTT
59
Which medication has the highest success rate in the treatment of Ogilvie syndrome?
Neostigmine
60
What is the recommended management if free air is detected under the diaphragm in a patient with Ogilvie syndrome?
Surgery
61
Critical cecal diameter and crosponding pressure thershold that increases the risk of rupture
12 cm diameter 26 cmh2o
62
Percentage of women that develop pyrexia in the first 48 hours after gyn surgery that don’t have identifiable cause
40% Most common cause of pyrexia: pulmonary atelectasis
63
Superficial SSI wound infection is most commly caused by which organism
staph aureus
64
How to ttt wound infection
Broad spectrum antibiotics Flucloxacillin If penicillin allergic: Clindamycin or Vancomycin
65
Commonest organisms leading to maternal sepsis
E. Coli GBS
66
Causes of most severe sepsis (death)
E COLI GAS
67
# **RECALL** what is the 1ry advantage of using joel cohen incision
reduce postoperative febrile morbidity
MRCOG - Part 2
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