Obstetrics Caesarean Section Techniques

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Questions and Answers

What is the recommended action regarding antibiotic administration for a caesarean section?

Give a broad-spectrum antibiotic two hours before the procedure regardless of the urgency.

Administer a single dose of a narrow-spectrum antibiotic one hour before the procedure.

Provide a broad-spectrum antibiotic prior to skin incision, irrespective of the operation being elective or emergency. (correct)

Start antibiotics postoperatively to prevent infections after delivery.

What should be considered before starting a caesarean section regarding tubal ligation?

Tubal ligation should be discussed only if the operation is elective.

Ensure that tubal ligation has been considered with necessary consent signed if it is the woman’s choice. (correct)

Consent for tubal ligation should be signed when the woman is in the post-operative recovery room.

Tubal ligation consent must be obtained only if the woman requests it.

Which factor necessitates consideration of a vertical skin incision during a caesarean section?

Risk of intra-operative haemorrhage. (correct)

A desire for a lower transverse incision.

Previous history of elective caesarean sections.

What is the correct dosage and timing for administering oxytocin post-delivery?

2.5 units IV slowly after delivery, to be repeated after 3 minutes if necessary. Signup and view all the answers

In case of excessive postpartum bleeding during a caesarean section, which is the priority action?

Inform the anaesthetist and obtain senior help while identifying bleeding points. Signup and view all the answers

What is the recommended fluid regimen immediately postoperatively for a woman undergoing caesarean section?

Ringer-Lactate 1 L with oxytocin over 8 hours, followed by 1 L of Plasmalyte. Signup and view all the answers

What is essential to know about the fetus before initiating a caesarean section?

The fetal heart activity, position, and presentation. Signup and view all the answers

What should be monitored in a caesarean delivery where the fetal head is deeply engaged?

Consider asking for assistance in pushing the baby up or using a reverse breech method. Signup and view all the answers

What is the correct calculation for determining the expected date of delivery (EDD) using Naegele's rule?

First day of last menstrual period plus 7 days minus 3 months plus 1 year Signup and view all the answers

What is an indication for performing a caesarean section during vacuum extraction?

The vacuum cup has been applied for more than 30 minutes Signup and view all the answers

During the application of a vacuum cup, what is the recommended suction pressure range for effective traction?

0.7 to 0.8 Bar Signup and view all the answers

What is the primary advantage of using forceps delivery compared to vacuum extraction?

More effective in face presentation Signup and view all the answers

How many maximum pulls are allowed during vacuum extraction?

3 pulls Signup and view all the answers

What aspect of the symphysis-fundal height (SFH) measurement assists in determining gestational age?

Comparing the measurement against the 50th centile line on the SFH graph Signup and view all the answers

What must be assessed before starting the vacuum extraction procedure?

Fetal heart rate only Signup and view all the answers

Which of the following scenarios would NOT lead to failed vacuum extraction?

There is noticeable descent with each pull Signup and view all the answers

What is the primary goal of managing diabetes in pregnancy?

To maintain maternal blood glucose levels in the normal range Signup and view all the answers

Which of the following is a complication associated with maternal diabetes during pregnancy?

Increased chance of congenital anomalies Signup and view all the answers

What is a recommended treatment for managing urinary tract infections (UTIs) during pregnancy?

Antibiotics that are safe in pregnancy Signup and view all the answers

Which infectious disease is particularly noted for its impact on maternal and fetal health during pregnancy?

HIV Signup and view all the answers

What is one of the primary objectives of maternal health audits?

To identify trends and discrepancies in maternal care Signup and view all the answers

What statistical measure is essential in assessing maternal mortality?

Maternal death rate per 1,000 live births Signup and view all the answers

What is a distinguishing characteristic of hyperthyroidism in pregnant women?

Typical presentation includes fatigue and weight loss Signup and view all the answers

Which maternal condition requires careful monitoring during pregnancy due to its potential complications?

Cardiac disease Signup and view all the answers

Which of the following is often associated with poor fetal outcomes in cases of maternal diabetes?

Poor glycemic control during pregnancy Signup and view all the answers

What is a common cause of perinatal death that requires awareness during pregnancy?

Preterm labor and intrauterine growth restriction Signup and view all the answers

Which of the following is critical in postpartum care for women with preexisting thyroid disorders?

Adjustment of thyroid medication dosages Signup and view all the answers

What is a key statistic often examined in maternal safety audits?

Maternal readmissions due to complications Signup and view all the answers

In the context of labor, what is essential for monitoring the outcomes for mothers with diabetes?

Constant glucose monitoring and assessment Signup and view all the answers

Study Notes

Introduction

An update of the 2013 Wits Obstetrics guidelines
Format is similar to the national Department of Health's Guidelines for Maternity Care in South Africa
Applies generally to three referral hospitals in South Africa
Useful in other hospitals in Johannesburg, including other Gauteng Province hospitals, and other hospitals in South Africa.

List of Abbreviations

Numerous medical abbreviations are defined. A complete list is provided in the document.

Chapter 1: Antenatal Care

Antenatal care aims to provide best pregnancy outcomes through preparation
Screening for high and low risk pregnancies
Management of potential problems during antenatal period
Information to pregnant women
Midwife-managed clinics for low-risk and hospital-managed clinics for high-risk pregnancies
Record detailing entire pregnancy, completed at each visit

Chapter 2: Labour, Delivery and Puerperium

Diagnosis of labour: regular uterine contractions along with cervical effacement and dilation or rupture of membranes (show)
Admission of a woman in labour: clinical findings documented, partogram entry if active labor
General care of women in labour
Routine monitoring
Fetal heart rate and maternal condition monitoring (e.g., BP, HR)
Instrumental delivery
Cesarean Section and immediate care of the newborn
Postpartum abnormalities
Management of primary and secondary postpartum haemorrhage

Chapter 3: Hypertension in Pregnancy

Definition of hypertension: Systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, on 2 occasions 24 hours apart, or a single BP ≥160/110 mmHg
Definitions of hypertensive disorders of pregnancy, including
Essential hypertension
Chronic renal disease
Pre-eclampsia
Gestational hypertension
Unclassified hypertension

Chapter 4: Common Obstetric Problems

Intrauterine growth restriction (IUGR) and its classifications (symmetric and asymmetric)
Rhesus incompatibility
Intrauterine death
Antepartum haemorrhage
Multiple pregnancy
Breech presentation
Prelabour rupture of the membranes
Chorionamnionitis
Fetal medicine and fetal tests including ultrasound scans, Doppler studies, NSTs
Obstetric emergencies: cord prolapse, fetal distress
Shoulder dystocia
Poor progress in second stage
Principles for instrumental deliveries (vacuum and forceps)
Repair of episiotomy, third-degree and similar tears
Detailed care for the newborn

Chapter 5: Fetal Medicine

The Fetal Medicine unit provides specialized fetal scans/investigations
The purpose of these scans and when they are recommended

Chapter 6: Medical Disorders

Anaemia and transfusion in pregnancy
Diabetes mellitus
Thyroid disease
Cardiac disease and anticoagulation
Infectious conditions
Sexual transmitted infections
UTI
Pneumonia and Tuberculosis

Chapter 7: Infectious Conditions

Sexually transmitted infections
Genital ulcers
Syphilis treatment and positive RPR

Chapter 8: Terminology, Audit and Statistics

Definitions of obstetric terms and classifications
Methods of recording data and statistics for audit purposes
Review of maternal and perinatal mortality rates
Detailed guidelines for management of maternal deaths

Additional Information

Abbreviations list (comprehensive)
Information for pregnant women
Schedule for subsequent and referral visits
Details on fetal wellbeing (ultrasound, NSTs, and fetal movement counts)
Guidelines for fetal distress and other emergencies
Care for the newborn: immediate care and resuscitation
Specific problems requiring referral: Proteinuria, vomiting, heartburn, constipation, haemorrhoids, urinary incontinence
High and intermediate risk factors lists
Detailed management of complicated pregnancies including conservative and operative strategies
Management of post-partum concerns, including PPH and sepsis
Care of the newborn in a range of circumstances
Details for induction of labour
Specifics for delivery of different fetal presentation types
Details about fetal medicine, including prenatal tests and indications
Detailed management for various infections, illnesses and conditions in pregnancy
Extensive details on the care of women with specific conditions such as cardiac disease or HIV.
Guidance for audit in maternity care
Definitions of relevant terms to obstetric care (gravidity, parity, etc.)

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Description

This quiz covers essential knowledge related to caesarean sections, including antibiotic administration, fluid regimens, and considerations for tubal ligation. Test your understanding of procedures and protocols vital for maternal and fetal health during this surgical intervention.