Anaesthesia and Abdominal Incisions Quiz

Questions and Answers

What is the primary purpose of administering antacids during labor?

To prevent aspiration pneumonia (correct)

To relieve pain during delivery

To counteract nausea caused by anesthesia

To enhance anesthesia efficacy

Which maneuver is used during endotracheal intubation to minimize the risk of aspiration?

Modified jaw thrust

Trendelenburg position

Valsalva maneuver

Sellick's maneuver (correct)

What is the characteristic feature of a Pfannensteil incision?

Circular incision around the umbilicus

Vertical incision along the midline

Incision made at a diagonal angle

Transverse curvilinear incision above pubic hairline (correct)

Which of the following is NOT a concern related to the use of general anesthesia in emergency situations?

Prolonged recovery time Signup and view all the answers

What is the recommended volume and concentration of sodium citrate given before surgery to mitigate risks associated with anesthesia?

30 ml of 0.3 molar solution Signup and view all the answers

What is the primary medication administered immediately after the delivery of the baby in the context of uterine closure?

Oxytocin Signup and view all the answers

Which type of sutures are specifically mentioned for controlling any bleeding points post-procedure?

Figure-of-eight sutures Signup and view all the answers

What type of forceps can be used to hold the uterine edges during the incision closure?

Allis forceps Signup and view all the answers

Which materials are indicated for closing the uterine incision?

Chromic catgut or polyglactin Signup and view all the answers

What immediate procedure follows the contraction of the uterine fundus after delivery?

Removing the placenta and membranes Signup and view all the answers

What is the purpose of using a Doyen retractor during the procedure?

To visualize the lower segment of the uterus Signup and view all the answers

What should be avoided to prevent complications during the incision in the lower segment?

Injuring uterine vessels lying laterally Signup and view all the answers

In cephalic presentation, what is the next step after the head is levered out gently?

Use forceps to deliver the floating head Signup and view all the answers

What is the first step in managing a transverse or oblique lie before making the uterine incision?

Perform a manual rotation to longitudinal lie Signup and view all the answers

In a breech presentation, what is the recommended method for delivery?

Hook the feet out first and complete vaginal delivery Signup and view all the answers

What is the primary reason for the name 'Caesarean section'?

It is named after a famous Roman military leader. Signup and view all the answers

What is included in the definition of a Caesarean section?

The delivery of a viable fetus through incision in the abdominal wall and uterus. Signup and view all the answers

What has contributed to the increase in Caesarean section rates?

Difficulties in vaginal breech deliveries and repeat Caesareans. Signup and view all the answers

What is the WHO-recommended ideal Caesarean section rate?

15-20% Signup and view all the answers

Which statement about Caesarean sections prior to the 20th century is true?

They were considered a fatal operation. Signup and view all the answers

Which of the following is a reason for increased diagnosis of intrapartum fetal distress?

Increased diagnosis during labor Signup and view all the answers

What is one of the common indications for a caesarian section?

Breech presentation Signup and view all the answers

Which indication is NOT associated with the decision to perform a caesarian section?

Maternal preference without complications Signup and view all the answers

Caesarian on demand is relevant in which context?

When there is a higher perceived risk from the current fetus Signup and view all the answers

Which condition is associated with an increased likelihood of cesarean delivery due to health complications?

Antepartum hemorrhage Signup and view all the answers

What material is used for closing the rectus sheath to reduce wound dehiscence?

Proline non-absorbable sutures Signup and view all the answers

Which layer of tissue is specifically stated to be closed during abdominal surgery?

Subcutaneous tissue Signup and view all the answers

What type of sutures may be used for the skin closure in abdominal surgery?

Mattress sutures of silk Signup and view all the answers

What is a critical component of post-operative care during the first 6-8 hours?

Close monitoring Signup and view all the answers

Which of the following is considered a part of post-operative care if needed?

Blood transfusion Signup and view all the answers

What is one of the advantages of a Low Segment Caesarean Section (LSCS)?

Improved recovery time Signup and view all the answers

Which type of incision is NOT classified as a type of Caesarean Section (CS)?

Transverse incision Signup and view all the answers

What is the typical timeframe for discharge after suture removal for a patient who undergoes a subcuticular Caesarean Section?

5th or 6th day post-surgery Signup and view all the answers

Which of the following recommendations is associated with post-operative care after a Caesarean Section?

Early ambulation and deep breathing exercises Signup and view all the answers

Which approach is a type of Caesarean Section performed when there is a need for hysterectomy?

Caesarean hysterectomy Signup and view all the answers

Which condition is NOT an indication for a caesarean hysterectomy?

Ovarian cysts Signup and view all the answers

What is a major risk during the caesarean section procedure?

Injury to the internal organs Signup and view all the answers

Which of the following is NOT a complication associated with a caesarean section?

Cardiovascular disease Signup and view all the answers

In what scenario might a caesarean hysterectomy be necessary?

Sepsis Signup and view all the answers

What complication can occur that directly affects the baby during a caesarean section?

Injury to the baby Signup and view all the answers

What is a primary indication for performing a lower segment vertical incision during a caesarean section?

Constrictive ring Signup and view all the answers

Which disadvantage is associated with a classical caesarean section?

Difficult healing Signup and view all the answers

What is a key indication for performing an extraperitoneal caesarean section?

Severe infection Signup and view all the answers

Which condition is NOT indicated for a classical caesarean section?

Lower segment not formed Signup and view all the answers

What potential complication is increased in subsequent pregnancies after a lower segment vertical incision?

Increased chance of rupturing during next pregnancy Signup and view all the answers

What is a common intervention for atonic primary hemorrhage during delivery?

Oxytocin 20 units in 500 ml Signup and view all the answers

Which complication is typically associated with trauma during delivery?

Ligation of concerned vessels Signup and view all the answers

Which of the following is NOT considered a postoperative complication?

Placenta accreta Signup and view all the answers

What is a potential complication arising from respiratory issues after surgery?

Pulmonary embolism Signup and view all the answers

Which treatment option is used for managing atonic primary hemorrhage?

Prostaglandin F2 alpha 250 microgram IM Signup and view all the answers

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.