Obs: L&D - CS and VBAC Flashcards
what is a caesarean section?
surgical operation to deliver the baby via an incision in the abdomen and uterus. It can be a planned procedure (elective caesarean) or performed where there are acute problems during the antenatal period or labour (emergency caesarean).
describe what is involved in an elective cs and when they are usually done
planned date when a woman will come in for delivery
usually performed under spinal anaesthetic
considered safe and routine procedure
usually performed after 39 weeks gestation
what are some indications for elective caesarean section?
- Previous caesarean
- Symptomatic after a previous significant perineal tear - 3rd/4th
- Placenta praevia
- Vasa praevia
- Breech presentation
- Multiple pregnancy
- Uncontrolled HIV infection
- Cervical cancer
what are the 4 categories of emergency cs?
- Category 1: There is an immediate threat to the life of the mother or baby. Decision to delivery time is 30 minutes.
- 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.
- Category 3: Delivery is required, but mother and baby are stable.
- Category 4: This is an elective caesarean, as described above.
most common skin incision is a transverse lower uterine segment incision. what are the 2 possible incisions:
pfannenstiel incision - curved incision 2 fingers width above pubic symphysis
joel-cohen incision - straight incision that is slightly higher - recommended incision
vertical incision down the middle can be used but it is rare, such as very premature deliveries and anterior placenta praevia
what are the layers of the abdomen that needed to be dissected during a caesarean are?
- Skin
- Subcutaneous tissue
- Fascia / rectus sheath (the aponeurosis of the transversus abdominis and 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
how does a spinal anaesthetic work?
local anaesthetic into csf which blocks nerves from abdomen downwards
(safer, few complications and faster recovery than GA but does take longer to initiate than GA)
what are some risks associated with having an anaesthetic?
- Allergic reactions or anaphylaxis
- Hypotension
- Headache
- Urinary retention
- Nerve damage (spinal anaesthetic)
- Haematoma (spinal anaesthetic)
- Sore throat (general anaesthetic)
- Damage to the teeth or mouth (general anaesthetic)
what are some measures taken to reduce risks during caesarean section?
- H2 receptor antagonists e.g. ranitidine or proton pump inhibitors e.g. omeprazole before the procedure - reduces risk of aspiration pneumonitis during cs caused by acid reflux and aspiration during prolonged period lying flat
- Prophylactic antibiotics during the procedure to reduce the risk of infection
- Oxytocin during the procedure to reduce the risk of postpartum haemorrhage
- Venous thromboembolism (VTE) prophylaxis with low molecular weight heparin
what are some general risks of cs?
bleeding
infection
pain
vte
what are some complications in the postpartum period?
pph
wound infection
wound dehiscence
endometritis
what structures are at risk of damage during a cs?
ureter
bladder
bowel
blood vessels
what are some effects on abdominal organs of a cs
ileus
adhesions
hernias
what are the effects on future pregnancies of cs
- Increased risk of repeat caesarean
- Increased risk of uterine rupture
- Increased risk of placenta praevia
- Increased risk of stillbirth
what are some risks to the baby of a cs
risk of laceration
increased incidence of transient tachypnoea of the newborn
