Questions and Answers
What is the primary purpose of administering antacids during labor?
Which maneuver is used during endotracheal intubation to minimize the risk of aspiration?
What is the characteristic feature of a Pfannensteil incision?
Which of the following is NOT a concern related to the use of general anesthesia in emergency situations?
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What is the recommended volume and concentration of sodium citrate given before surgery to mitigate risks associated with anesthesia?
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What is the primary medication administered immediately after the delivery of the baby in the context of uterine closure?
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Which type of sutures are specifically mentioned for controlling any bleeding points post-procedure?
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What type of forceps can be used to hold the uterine edges during the incision closure?
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Which materials are indicated for closing the uterine incision?
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What immediate procedure follows the contraction of the uterine fundus after delivery?
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What is the purpose of using a Doyen retractor during the procedure?
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What should be avoided to prevent complications during the incision in the lower segment?
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In cephalic presentation, what is the next step after the head is levered out gently?
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What is the first step in managing a transverse or oblique lie before making the uterine incision?
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In a breech presentation, what is the recommended method for delivery?
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What is the primary reason for the name 'Caesarean section'?
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What is included in the definition of a Caesarean section?
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What has contributed to the increase in Caesarean section rates?
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What is the WHO-recommended ideal Caesarean section rate?
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Which statement about Caesarean sections prior to the 20th century is true?
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Which of the following is a reason for increased diagnosis of intrapartum fetal distress?
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What is one of the common indications for a caesarian section?
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Which indication is NOT associated with the decision to perform a caesarian section?
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Caesarian on demand is relevant in which context?
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Which condition is associated with an increased likelihood of cesarean delivery due to health complications?
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What material is used for closing the rectus sheath to reduce wound dehiscence?
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Which layer of tissue is specifically stated to be closed during abdominal surgery?
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What type of sutures may be used for the skin closure in abdominal surgery?
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What is a critical component of post-operative care during the first 6-8 hours?
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Which of the following is considered a part of post-operative care if needed?
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What is one of the advantages of a Low Segment Caesarean Section (LSCS)?
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Which type of incision is NOT classified as a type of Caesarean Section (CS)?
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What is the typical timeframe for discharge after suture removal for a patient who undergoes a subcuticular Caesarean Section?
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Which of the following recommendations is associated with post-operative care after a Caesarean Section?
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Which approach is a type of Caesarean Section performed when there is a need for hysterectomy?
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Which condition is NOT an indication for a caesarean hysterectomy?
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What is a major risk during the caesarean section procedure?
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Which of the following is NOT a complication associated with a caesarean section?
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In what scenario might a caesarean hysterectomy be necessary?
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What complication can occur that directly affects the baby during a caesarean section?
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What is a primary indication for performing a lower segment vertical incision during a caesarean section?
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Which disadvantage is associated with a classical caesarean section?
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What is a key indication for performing an extraperitoneal caesarean section?
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Which condition is NOT indicated for a classical caesarean section?
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What potential complication is increased in subsequent pregnancies after a lower segment vertical incision?
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What is a common intervention for atonic primary hemorrhage during delivery?
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Which complication is typically associated with trauma during delivery?
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Which of the following is NOT considered a postoperative complication?
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What is a potential complication arising from respiratory issues after surgery?
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Which treatment option is used for managing atonic primary hemorrhage?
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Study Notes
Anaesthesia
- General Anaesthesia (GA) or Regional Anaesthesia options available, including Spinal and Epidural.
- Mendelson's syndrome risk during emergency GA due to aspiration leading to chemical pneumonitis.
- Preventative measures include administering antacids during labour and withholding oral fluids.
- 30 ml of 0.3 molar sodium citrate is given 30 minutes before surgery.
- Sellick's manoeuvre is performed during endotracheal intubation for pressure application.
Abdominal Incisions
- Pfannensteil incision is the most commonly used, featuring a transverse curvilinear shape above the pubic hairline.
- Incision deepens through subcutaneous tissue to the rectus sheath.
Closure of Uterine Incision
- Oxytocin infusion is started immediately after delivery to promote uterine contraction and expulsion of placenta and membranes.
- The uterine cavity is wiped with a moist pad to ensure it's empty; the cervical canal must be open.
- Uterine edges are held with Allis or Green Armytage forceps; the incision is closed in two layers using continuous sutures.
Materials
- Suturing materials include chromic catgut or polyglactin.
Post-Procedure
- Control of any bleeding points with figure-of-eight sutures is crucial.
Delivery of Baby
Cephalic Presentation
- The hand is introduced into the uterine cavity to gently lever out the head.
- Use forceps if the head is floating to assist delivery.
Breech Presentation
- Feet are delivered first, followed by the rest of the body through vaginal breech delivery.
Transverse or Oblique Lie
- Must be corrected to a longitudinal lie prior to making the uterine incision.
Caesarean Section
- Named after Julius Caesar, who was traditionally believed to have been born via this method.
- It was considered fatal until the early 20th century; now, it's the most common surgical procedure worldwide.
- Defined as the delivery of a viable fetus via incision in the abdominal wall and uterus, excluding cases of uterine rupture.
- WHO recommends an optimal Caesarean rate of 15-20%; however, many countries exceed this rate.
Reasons for Increased Caesarean Rates
- Increased repeat Caesarean sections and difficult instrumental deliveries contribute to rising numbers.
- Intrapartum fetal distress is now more readily diagnosed.
- Caesarean requests by patients and risks for mothers and fetuses have been recognized.
- Increased pregnancies via in vitro fertilization also lead to higher rates.
Indications for Caesarean Section
- Previous Caesarean section.
- Dystocia or dysfunctional labour.
- Fetal distress or breech presentation.
- Antepartum haemorrhage or maternal health issues.
- Elective Caesarean section on demand.
LSCS (Lower Segment Caesarean Section) Closure
- The peritoneum may or may not be closed; non-absorbable sutures (e.g., proline) are used for the rectus sheath to minimize wound issues.
- Subcutaneous tissue is closed; skin is sealed using mattress sutures, subcuticular sutures, or clips.
Postoperative Care
- Close monitoring for the first 6-8 hours; provision of parenteral fluids and blood transfusions if necessary.
- Administration of analgesics and sedatives recommended.
- Encourages early ambulation, deep breathing exercises, light diet, and laxatives.
- Patients can typically be discharged after sutures removal or between the 5th and 6th post-operative days if healed adequately.
Advantages of LSCS
- Improved healing outcomes and reduced chances of scar rupture.
Other Types of Caesarean Sections
- Low segment vertical incision.
- Classical Caesarean.
- Extraperitoneal Caesarean.
- Caesarean hysterectomy.
Caesarean Hysterectomy Indications
- Severe atonic postpartum haemorrhage, placenta accreta, or sepsis.
- Presence of multiple large myomas or cervical cancer.
Complications of Caesarean Section
Intraoperative Complications
- Risks include primary haemorrhage, internal organ injury, and fetal injury.
Postoperative Complications
- Issues can include paralytic ileus, respiratory problems, infections, peritonitis, pelvic abscess, and thrombosis.
- Wound dehiscence is a notable concern.
Special Circumstances
Lower Segment Vertical Incision
- Used for cases like constriction rings where the lower segment isn't formed, but carries risks of cervix, vagina, or bladder injury.
Classical Caesarean
- Indicated when the lower segment is inaccessible or in cases involving cervical cancer or complex obstetric scenarios.
- Challenges include difficult healing and increased risk of scar rupture.
Extraperitoneal Caesarean
- An approach used in cases of severe infection, providing access to the space of Retzius.
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Description
Test your knowledge on anaesthesia techniques, including general anaesthesia (GA) and regional anaesthesia specifics like spinal and epidural methods. Additionally, explore the common abdominal incisions such as the Pfannensteil incision. This quiz covers essential concepts for aspiring medical professionals.