What is a CS section defined as with reference?
‘an operative procedure which is carried out under anaesthesia (regional or general), whereby the fetus, placenta and membranes are delivered through an incision made in the abdominal wall and uterus’
(Hayman, 2015)
between 2015-2016 how many births were CS sections (in percentage)
27% if total births
Define Category 1 CS section
with ref
Immediate threat to life of the woman or fetus
NICE, 2011
Define Category 2 CS section
with ref
Maternal or fetal compromise which is not immediately life threatening
Define Category 3 CS section
with ref
No maternal or fetal compromise but needs early delivery
NICE,2011
Define Category 4 CS section
with ref
Delivery timed to suit woman or staff
NICE,2011
How long should the interval be when making a decision to do EMCS?
- Category 1: 30 minutes
* Category 2: up to 75 minute
Name the things done to prepare a woman for EMCS ?
- Discussion and informed consent – involve partner
- Documentation
- Bloods taken for FBC, G & S ( X match if necessary) (if time)
- Anaesthetic discussion and plan (antacid)
- Antibiotic prophylaxis
- Prepare for theatre (pubic hair prep, jewellery removal, name band, gown, transfer to theatre, catheterise, ?partner in gown)-Skin cleaned and prepare
What staff are present in an EMCS?
- Surgeons
- Anaethetist
- Scrub nurse/midwife
- Receiving midwife
- paediatrician/ANNP/neonatal nurse
- ODP/theatre nurse
- Partner (?)
What procedure is done during EMCS?
- Incision - usually transverse lower segment
- Layers that need to be incised: skin, subcutaneous fat, rectus sheath, (rectus abdominus (muscle) is parted), abdominal peritoneum, uterus (muscle)
- The peritoneum above the bladder is incised and the bladder moved out of the way (reflected down)
- The uterine muscle should be incised carefully to avoid trauma to the fetus (NB amniotic fluid)
- The surgeon then delivers the baby whilst the surgeon’s assistant applies fundal pressure
- Cord then clamped and cut
- Baby passed to receiving midwife and taken to resuscitaire
- Neonatal resuscitation may be required
- Skin to skin encouraged in theatre if appropriate
- Oxytocin IV (5iu) (NICE 2011)
- Placenta and membranes delivered by CCT
- Uterus closed in 2 layers, rectus sheath and skin sutured
- Wound dressed
- Vagina swabbed to remove clot
What Neonatal Care will be given to the Neonate after the EMCS?
- Resuscitation may be needed
- Paediatrician should be present at delivery
- Umbilical artery blood pH should be taken if suspected fetal compromise
- Keep baby warm!
- Skin to skin if appropriat
What postnatal care would you provide t both the mother and the neonate?
- Post operative recovery observations (BP, P, R, T, wound, lochia, pain) 15 mins for 30 mins, then 30 mins for 2 hours, hourly then 4 hourly
- Thromboprophylaxis (NICE 2011)
- Pain relief
- Bladder care - catheter removal
- Skin to skin encouraged
- Breastfeeding support
- Wound assessment and care (NB. may also have perineal wound)
- Postnatal exercises and PFE encouraged
- DEBRIEF (provide verbal and written information NICE 2011)
What risks are associated with CS section?
- Increased morbidity/mortality
- Increased risk of post-operative infection (wound, UTI, uterine, genital tract)
- Increased blood loss, increased risk postnatal anaemia
- Tiredness
- Pain
- Psychological support
