CesareanDelivery Flashcards
(34 cards)
What are the fetal indications for CS?
Abnormal presentation: BReech & transverse
Abnormal size: macrosomia
Abnormal number: multifetal pregnancy especially if malpresented
Abnormal fetus: congenital anomalies
Unhealthy fetus: non-reassuring status, cord prolapse and fetal distress, bradycardia, late deccelerations
What are the maternal indications for CS?
Genital tract obstruction = tumor previa, excessive lower tract lesion that can bleed (condyloma, cervical caner, permanent coerciage)
Infections = HSV, HIV
Pelvic abnormality = small/deformed
Maternal conditions = cardiac, pulmonary, aneurysms, stroke
Concurrent patho = needs to be removed
Perimortem CS
Failed operative vaginal delivery
What are the most common indications for CS?
- Labor arrest
- Non-reassuring fetal tracing
- Malpresentation
What are the diff uterine incisions?
Low transverse or Kerr (A)
Low vertical or Kronig (B)
Classical Incision (C)
J-incision (D)
T-incision (E)
What is the most common & performed uterine incision in CS? Why?
Low transverse or Kerr (A)
- good healing, least bloody, easiest to repair
What is the least preferred uterine incision in CS? What are its indication?
Classical incision
- more blood loss
- deliveries with anticipated difficulty in manipulation or when a bigger incision is required
What uterine incicision has an incision extended vertically upwards?
J-incision (D)
What type of uterine incision is used to make a vertical extension of the low transverse incision? where is the weakest point of this incision?
T-incision (E)
Weakest point: intersection betw transverse & vertical incision
What is the most frequent abdominal incisions for CS?
Pfannenstiel incision and midline vertical incision
What are the indications for Pfannenstiel incision?
Cosmetically appealing
Heals better
Less prone to dehiscence or hernia
Aka Primary low transverse cesarean section
What are other necessary procedures can you do during cesarean section?
Removal of ovarian new growth
Tubal ligation or sterilization
Removal of myoma
What is the most commonly used uterine incision repair?
Three-layer repair
1st layer: endo-myometrial
2nd layer: myometrium
3rd layer: serosa
What is the AOG for recommended for CS on demand?
ACOG (2018) recommendation
NOT EARLIER THAN 39 WEEKS
What are the diff intraoperative complications of CS?
Anesthesia accidents
Hemorrhage
Injury to pelvic and adjacent organs
Wound dehiscence
What are the diff postapartum complications of CS?
Infections
Thromboembolism
What are the future risks for CS?
Uterine dehiscence and rupture
Abruptio placenta
Placenta previa
Placenta accreta syndrome
Ectopic pregnancy
Intrapartum hemorrhage
Peripartum hysterectomy
What are the prerequisites of vaginal birth after cesarean (VBAC)?
Only 1 previou cesarean delivery
Low transverse incision
Non-recurring indication for CS
No cephalopelvic disproportion
No other uterine scars or previous rupture
No maternal medical condition
Interpregnancy interval >18 months
What condition occurs when there is through and through disruption of all uterine layers that can occur after VBAC?
Uterine rupture
What is the earliest sign of uterine rupture?
Fetal tachycardia
What are the signs & symptoms of uterine rupture?
Sudden tearing pain on abdomen
Hemorrhage: hypotension, tachycardia, pallor, vaginal bleeding
Fetus extruded out of uterus: fetal parts easily palpable abdominally, loss of station of presenting part
Fetal heart deceleration & bradycardia (lates sign) or tachycardia
What is the separation of the previou cesaerean scar with the serosa of the uterus intact with absent hemorrhage & milder than uterine rupture?
Uterine dehiscence
What is the removal of the uterus?
Hysterectomy
what is the type of hysterectomy done at around the time of delivery?
Peripartum hysterectomy
What is the type of hysterectomy where removal of uterus is in conjunction with a planned or unplanned Cesarean delivery?
Cesarean hysterectomy
