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What is a Cesarean Section?
A Cesarean Section is a procedure in which the fetus is delivered through incisions in the maternal anterior abdominal and uterine walls.
What are the main risks associated with Cesarean Sections?
- Maternal mortality and morbidity (especially with emergency C-sections)
- Hemorrhage (blood loss is about 2x that of vaginal delivery)
- Infection (including sites like the endometrium, abdominal wall, and urinary tract)
- Visceral injury (e.g., bowel, bladder, ureters)
- Thrombosis (increased risk of DVT in pelvic and lower extremity veins)
What are the advantages and disadvantages of a low segment transverse uterine incision?
Advantages:
- Low risk of uterine rupture (0.5%)
- Safer for trial of labor in subsequent pregnancies
- Less bleeding and fewer adhesions
Disadvantages:
- Fetus must be in a longitudinal lie
- Lower uterine segment must be well-developed
What are the risks of a classical uterine incision?
- Higher risk of uterine rupture (5%)
- More blood loss and adhesions
- Unsafe for trial of labor in subsequent pregnancies
What should be done in postoperative care after a Cesarean Section?
Pain medication, initially IV, then oral
Encourage movement, fluids, and eating after anesthesia wears off
Breastfeeding can begin immediately
The abdominal incision heals over weeks with mild cramping, light bleeding, or vaginal discharge
Monitor for fever, worsening pain/bleeding, or any new concerns like severe headache or abdominal pain
What is the recommended interval before attempting another pregnancy after a Cesarean Section?
The interval should be about 18–23 months, as shorter intervals increase the risk of uterine rupture.
What are the criteria for a trial of labor after Cesarean Section (VBAC)?
- Patient consent
- Non-repetitive Cesarean indication (e.g., breech, placenta previa)
- Previous low segment transverse uterine incision
- Clinically adequate pelvis
What are the advantages and disadvantages of a classical uterine incision?
Advantages:
- Can deliver any fetus regardless of intrauterine orientation
- Can bypass lower segment varicosities or myomas
Disadvantages:
- Unsafe for trial of labor in subsequent pregnancies
- Higher risk of bleeding and adhesions
What is the most common cause of Cesarean Section?
The most common causes are:
1. Failure to progress (35-40%)
2. Fetal distress (25%)
3. Fetal malpresentation
What is included in postoperative care for a Cesarean Section?
- Pain medication (IV initially, then oral)
- Early ambulation (4-6 hours) to decrease the risk of deep vein thrombosis (DVT)
- Removal of Foley catheter (4-6 hours after surgery)
- Breastfeeding as soon as possible
- Pediatric exam for the baby within the first 24 hours
When can the individual shower after a Cesarean Section?
Can shower after 2-3 days, covering the wound area.
After 3 days, no need to cover but avoid friction and do not scrub the area.
What symptoms can be expected post Cesarean Section?
- Mild cramping due to uterine contractions
- Light bleeding and vaginal discharge
- Numbness around the incision site
- Incisional pain, which typically heals by 6 weeks postpartum
What should a patient do if they experience symptoms such as fever, worsening pain, or other concerns after a Cesarean Section?
The patient should notify the healthcare provider if they develop:
1. Fever (temperature greater than 100.4°F [38°C])
2. Worsening pain or bleeding
3. Severe headache, abdominal pain, or difficulty breathing
What is the recommended dressing care for the surgical incision after a Cesarean Section?
- The dressing should be kept on for 2-3 days due to epithelialization.
- After this period, the dressing can be removed to allow the incision to heal naturally.
What is the general postpartum care advice regarding Cesarean Section incisions?
- The incision site should not be rubbed or subjected to friction for a few weeks to allow proper healing.
- It is normal to experience mild discomfort and numbness around the incision site for several months.
What are the categories to determine the timing of a cesarean delivery?
- Immediate threat to life (immediate, crash CD)
- Maternal or fetal compromise (urgent)
- No compromise but needs early delivery (scheduled)
- Delivery timed to suit woman and staff (elective)
These categories help prioritize cesarean deliveries based on urgency.
In cases of suspected or confirmed acute fetal compromise, when should delivery occur?
As soon as possible
The accepted standard for category 1 (immediate) cesarean delivery is within 30 minutes.
What are the indications for category 1 cesarean delivery?
- Placental abruption with abnormal FHR or uterine irritability
- Cord prolapse
- Scalp pH <7.20
These conditions require immediate intervention to protect the mother and fetus.
What is an indication for category 2 cesarean delivery?
Pathological CTG in the first stage of labor
This indicates a need for urgent intervention due to fetal distress.
What are the indications for category 3 (scheduled) cesarean delivery?
FGR with poor fetal function tests
This indicates a need for planned intervention to ensure fetal well-being.
What are the indications for category 4 (elective) cesarean delivery?
- Term singleton breech (if ECV is contraindicated or has failed)
- Twin pregnancy with non-cephalic 1st twin
- Maternal HIV
- 1° genital herpes in the 3rd trimester
- Placenta praevia
- Previous hysterotomy or classical CD
These conditions warrant a planned cesarean delivery to ensure safety.
What is the major complication most common with an emergency Caesarean delivery?
Anaesthesia-related maternal deaths
These complications occur in women undergoing CD with general anaesthesia.
Intraoperative complications occur in what percentage of Caesarean deliveries?
12-15%
These complications can include various lacerations and blood loss.
