9.14 Caesarean Section Flashcards
After what week are elective c-sections usually done?
Usually after 39 weeks
What anaesthetic is used in c-section?
spinal anaesthetic (lidocaine)
awake, takes longer than a GA to take effect
What are the indications for an elective c-section?
- previous c-section
- symptomatic after a previous perineal tear
- placenta previa
- vasa previa
- breech presentation
- multiple pregnancy
- uncontrolled HIV
- cervical cancer
How many categories of c-section are there?
4
What is a Category 1 c-section?
Category 1: There is an immediate threat to the life of the mother or baby. Decision to delivery time is 30 minutes.
What is a Category 2 c-section?
Category 2: There is not an imminent threat to life, but caesarean is required urgently due to compromise of the mother or baby. Decision to delivery time is 75 minutes.
What is a Category 3 c-section?
Category 3: Delivery is required, but mother and baby are stable.
What is a Category 4 c-section?
Category 4: This is an elective caesarean.
What incisions are possible for a c-section?
- Pfannenstiel incision is a curved incision two fingers width above the pubic symphysis
- Joel-cohen incision is a straight incision that is slightly higher (this is the recommended incision)
A vertical incision down the middle of the abdomen is also possible, but this is rarely used (eg very premature deliveries and anterior placenta praevia)
What layers of the abdomen need to be dissected during a c-section? (8)
- Skin
- Subcutaneous tissue
- Fascia / rectus sheath (aponeurosis of transversus abdominis, + external and internal oblique muscles)
- Rectus abdominis muscles (separated vertically)
- Peritoneum
- Vesicouterine peritoneum (and bladder) – the bladder is separated from the uterus with a bladder flap
- Uterus (perimetrium, myometrium and endometrium)
- Amniotic sac
What are 8 risks associated with having an anaesthetic?
- allergic reaction
- hypotension
- headache
- urinary retention
Spinal:
- nerve damage
- haematoma
GA:
- sore throat
- damage to teeth or mouth
What meds are given to reduce risks during a c-section?
- H2 receptor antagonists (ranitidine) or PPI (omeprazole) to reduce acid reflux and aspiration
- prophylactic Abx
- oxytocin to reduce risk of postpartum haemorrhage
- LMWH to reduce VTE
Complications of c-section: general surgical risks?
Bleeding
Infection
Pain
Venous thromboembolism
Complications of c-section: postpartum period?
Postpartum haemorrhage
Wound infection
Wound dehiscence
Endometritis
Complications of c-section: damage to local structures?
Ureter
Bladder
Bowel
Blood vessels
