C-section

Question 1

2 types

Answer 1

1. lower segment c-section - 99%
2. classic c-section - longitudinal incision in the upper segment of the uterus

Question 2

indications

Answer 2

absolute cephalopelvic disproportion

placenta praevia grades 3/4

pre-eclampsia

post-maturity

IUGR

fetal distress in labour/prolapsed cord

failure of labour to progress

malpresentations: brow

placental abruption: only if fetal distress; if dead deliver vaginally

vaginal infection e.g. active herpes

cervical cancer (disseminates cancer cells)

Question 3

what is the c-section categorisation based on?

Answer 3

urgency

Question 4

categories of c-section

Answer 4

Category 1

-an immediate threat to the life of the mother or baby

examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
delivery of the baby should occur within 30 minutes of making the decision

Category 2

-maternal or fetal compromise which is not immediately life-threatening

• delivery of the baby should occur within 75 minutes of making the decision

Category 3

• delivery is required, but mother and baby are stable

Category 4

• elective caesarean

Question 5

serious maternal risks of C-section

Answer 5

emergency hysterectomy

need for further surgery at a later date, including curettage (retained placental tissue)

admission to intensive care unit

thromboembolic disease

bladder injury

ureteric injury

death (1 in 12,000)

Question 6

serious risks to future pregnancies

Answer 6

increased risk of uterine rupture during subsequent pregnancies/deliveries

increased risk of antepartum stillbirth

increased risk in subsequent pregnancies of placenta praevia and placenta accreta)

Question 7

frequent risks to mother

Answer 7

persistent wound and abdominal discomfort in the first few months after surgery

increased risk of repeat caesarean section
when vaginal delivery attempted in subsequent pregnancies

readmission to hospital

haemorrhage

infection (wound, endometritis, UTI)

Question 8

frequent risks to baby

Answer 8

lacerations, one to two babies in every 100

Question 9

what is a VBAC

Answer 9

Vaginal birth after Caesarean

planned VBAC is an appropriate method of delivery for pregnant women at >= 37 weeks gestation with a single previous Caesarean delivery

most women fine

Question 10

contraindications to VBAC

Answer 10

previous uterine rupture or classical caesarean scar