Caesarean Section

Question 1

How can CS be classified?

Answer 1

Emergency:

1 = Immediate threat to the life of the woman or fetus

2 = Maternal or fetal compromise that is not immediately life-threatening

3 = No maternal or fetal compromise but needs early delivery

Elective

Question 2

List the indications for a CS

Answer 2

• Breech
• Malpresentations
• Twins
• Maternal conditions
• Failure to progress
• Fetal compromise
• Transmissible disease
• Primary genital herpes
• Placenta praevia
• Maternal DM
• Previous major shoulder dystocia
• Previous 3rd/4th perineal tear

Question 3

What steps should be taken prior to CS?

Answer 3

Bloods = FBC, G+S

H2RA = Ranitidine +/- metoclopramide

VTE risk score (stockings, LMWH)

Question 4

Outline the anaesthesia of CS

Answer 4

Regional anaesthetic – this is usually an ‘topped-up’ epidural or a spinal anaesthetic

Sometimes GA

Question 5

Briefly outline the steps in a CS

Answer 5

L lateral tilt of 15°

Foleys catheter

Incision = transverse lower abdo

LAYERS =
- Skin
- Camper’s fascia (superficial fatty layer of subcutaneous tissue)
- Scarpa’s fascia, (deep membranous layer of subcutaneous tissue)
- Rectus sheath, (anterior and posterior leaves laterally, that merge medially)
- Rectus muscle,
- Abdominal peritoneum (parietal)
this reveals the gravid uterus
- Visceral peritoneum
- Uterus

Delivery

Oxytocin 5iu IV - aid placental delivery

Question 6

What are the possible complications post-CS

Answer 6

Reduced risk = perineal trauma and pain, urinary and anal incontinence, uterovaginal prolapse, late stillbirth and early neonatal infections (compared with vaginal birth)

Immediate =

• postpartum haemorrhage
• wound haematoma
• transient tachypnoea of the newborn (retention of lung fluid)
• fetal lacerations

Intermediate =

• UTI
• endometritis
• VTE

Late =

• fistula
• subfertility
• psychological
• scar