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Caesarean section (Indications (Malpresentation (breech, transverse),…
Caesarean section
Indications
Malpresentation (breech, transverse)
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Classification
Category 2
Maternal/foetal compromise, not imminently
life threatening e.g. failed progression
Delivery 30-60m from decision
Category 3
No immediate threat, semi elective
E.g. pre-eclampsia, failed OIL
Category 1 (crash)
Immediate life threat to woman/foetus e.g.
abruption, foetal bradycardia
Delivery <30m of decision
Category 4
Elective CS e.g. term singleton breech
After 39w (reduce transient tachypnoea of the newborn);
if before, need to give steroids
Procedure
Procedures
Neutralise stomach acid (sodium citrate), plus metoclopramide to promote gastric emptying
Cannulate, bloods (G+S, crossmatch)
Catheterise
Prophylactic abx
Alert staff
Anaesthatist, obstetrician, theatre staff,
paediatrician, neonatal team
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Complications
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Long term
PP or PA in subsequent pregnancies
Uterine rupture with spontaneous labour
Antepartum stillbrith in next pregnancies
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Aftercare
Monitoring
HR, RR, BP, temp, sedation levels
(every 30m for first 2h, then hourly for 24h)
MEOWS chart (Mod Early Obs Warning Score)
Actions
Promote skin to skin
Early mobilisation
Check wounds
Analgesia (paracetamol, ibuprofen, morphine breakthrough)
Discuss reason for CS, future birth options, contraception
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Types
Lower uterine segment
Straight, 3cm above symphysis pubis
Blunt dissection thereafter
Reduced adhesions, blood loss, scar dehiscence
Classical CS
Vertical incision on uterus (rarely used)
Indications: very premature, transverse lie, structural abnormality, fibroids in lower segment, anterior PP
More adhesions and infection
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