1. The document provides guidelines for caesarean section (CS) based on specific clinical indications and situations. It discusses recommendations for various techniques and practices surrounding CS to reduce risks and improve outcomes for both the mother and baby.
2. Guidelines are given for CS in cases of breech presentation, multiple pregnancy, preterm birth, small for gestational age, and placenta praevia. Predictors of difficult vaginal birth are also addressed. Medical conditions that may require planned CS like HIV are covered.
3. Detailed recommendations are provided for surgical techniques, anaesthesia, post-operative care, and pain management to minimize complications and optimize recovery from CS. Guidelines aim to improve safety, reduce
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Adaptation and Implementation of Evidence-Based Clinical Practice Guidelines for Antibiotic Prophylaxis in Surgery in King Saud University Hospitals in Riyadh, Saudi Arabia
CONTROVERSIES in INDUCTION OF LABOR Dr. Dipti Nabh , Dr. Sharda Jain Lifecare Centre
GRAND MULTIPARA
FIGO definition - GM taken as delivery of 5th to 9th Infant, 10th and above taken as great GM
Prevalence - Gulf countries and African sub-continent
Risks with increasing parity -
Maternal
Dysfunction labor
Uterine rupture
Morbid adherence of placenta
Unstable lie & presentation
Precipitate deliveries
UV Prolapse
Medical condition due to increasing age
Fetal
1 Low APGAR score
2 Meconium aspiration syndrome
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
3. .
a CS that is scheduled
before the onset of labour for
a specific clinical indication.
Aboubakr Elnashar
4. 1 Breech presentation
uncomplicated singleton breech at 36w:
external cephalic version.
Exceptions:
in labour
uterine scar or abnormality,
fetal compromise,
ruptured membranes,
vaginal bleeding or
medical conditions.
Aboubakr Elnashar
5. singleton breech presentation at
term, for whom external cephalic
version is contraindicated or has
been unsuccessful, should be
offered CS because it reduces
perinatal mortality and neonatal
morbidity.
Aboubakr Elnashar
6. 2 Multiple pregnancy
first twin is cephalic {CS in
improving outcome for the
second twin is uncertain}
CS should not routinely be
offered
Aboubakr Elnashar
7. First twin is not cephalic {CS
improving outcome is uncertain},
but current practice is to offer
CS.
Planned CS for uncomplicated
twin pregnancy should not be
carried out before 38 w{increases
respiratory problems}
Aboubakr Elnashar
8. 3 Preterm birth
{effect of planned CS in
improving outcomes
remains uncertain}
CS should not routinely
offered
Aboubakr Elnashar
9. 4 Small for gestational
age
{the effect of planned CS
in improving outcomes
remains uncertain}
CS should not routinely
offered Aboubakr Elnashar
10. 5 Placenta Praevia
a placenta that partly or
completely covers the
internal cervical os
(grade 3 or 4 placenta
praevia): CS.
Aboubakr Elnashar
12. 1 Pelvimetry is not useful
in predicting ‘failure to
progress’in labour and
should not be used in
decision making about
mode of birth.
Aboubakr Elnashar
13. 2 Shoe size, maternal height
and estimations of fetal size
(ultrasound or clinical
examination) do not
accurately predict CPD and
should not be used to predict
‘failure to progress’ during
labour. Aboubakr Elnashar
16. 2 Hepatitis B:
Should not be offered a
planned CS {insufficient
evidence that this
reduces mother-to-child
transmission}
Aboubakr Elnashar
17. 3 Hepatitis C:
should not be offered
a planned CS {does
not reduce mother-to-
child transmission}
Aboubakr Elnashar
18. 4 Hepatitis C virus
and HIV:
should be offered
planned CS because
it {reduces mother-to-
child transmission}Aboubakr Elnashar
19. 5 Primary genital (HSV)
infection in the third
trimester of pregnancy:
planned CS {decreases
the risk of neonatal
HSV infection}.
Aboubakr Elnashar
20. 6 Recurrence of HSV:
{uncertainty about the
effect of planned CS in
reducing the risk of
neonatal HSV infection}.
CS should not routinely
offered Aboubakr Elnashar
22. 1. Benefits and risks
of CS compared with
vaginal birth should
be discussed and
recorded.
Aboubakr Elnashar
23. 2. A fear of childbirth:
counselling (cognitive
behavioural therapy)
{this results in reduced
fear of pain in labour
and shorter labour}.
Aboubakr Elnashar
24. 3. Clinician has the right to
decline a request for CS in
the absence of an identifiable
reason.
4. The woman’s decision
should be respected and she
should be offered referral for
a second opinion.Aboubakr Elnashar
30. 5 Electronic fetal
monitoring is associated
with an increased
likelihood of CS.
Fetal blood sampling
should be offered
Aboubakr Elnashar
31. No influence on likelihood
of CS
1
• walking in labour
• non-supine position
• immersion in water
• epidural analgesia
• the use of raspberry leaves.Aboubakr Elnashar
34. 4. Eating a low-residue diet
(toast, crackers, low-fat cheese)
results in larger gastric volumes,
but the effect on the risk of
aspiration if anaesthesia is
required is uncertain.
5 Isotonic drinks prevents
ketosis without a concomitant
increase in gastric volume.Aboubakr Elnashar
39. 2 Pregnant women having CS
for antepartum haemorrhage,
abruption, uterine rupture and
placenta praevia are at
increased risk of blood loss of
more than 1000 ml and should
have the CS carried out at a
maternity unit with on-site blood
transfusion services.Aboubakr Elnashar
40. 3 Pregnant women who are healthy and
who have otherwise uncomplicated
pregnancies should not routinely be offered
the following tests before CS:
• grouping and saving of serum
• cross-matching of blood
• a clotting screen
• pre-operative ultrasound for localization of
the placenta {does not improve CS morbidity
outcomes (such as blood loss of more than 1000
ml, injury of the infant, and injury to the cord or to
other adjacent structures)}.Aboubakr Elnashar
41. 4 Women having CS with
regional anaesthesia require
an indwelling urinary catheter
{prevent over-distension of
the bladder, because the
anaesthetic block interferes
with normal bladder
function}. Aboubakr Elnashar
43. The following recommendations
for surgical techniques apply to
pregnancies at term where there
is a lower uterine segment.
Techniques may need
modification in situations such as
repeat CS or placenta praevia.
Aboubakr Elnashar
44. 1 Double gloves when
performing or assisting at CS
on women who have tested
positive for HIV {reduce the
risk of HIV infection}.
2 General recommendations for
safe surgical practice {reduce
the risk of HIV infection of staff}.Aboubakr Elnashar
45. 3 Transverse abdominal
incision {less
postoperative pain and
an improved cosmetic
effect compared with a
midline incision}.
Aboubakr Elnashar
46. 4 The transverse incision of
choice should be the Joel Cohen
incision (a straight skin incision, 3
cm above the symphysis pubis;
subsequent tissue layers are
opened bluntly and, if necessary,
extended with scissors and not a
knife) {shorter operating times and
reduced postoperative febrile
morbidity}.
Aboubakr Elnashar
47. 5 The use of separate
surgical knives to incise
the skin and the deeper
tissues is not
recommended {does not
decrease wound
infection}. Aboubakr Elnashar
48. 6 When there is a well
formed lower uterine
segment, blunt rather than
sharp extension of the
uterine incision {reduces
blood loss, incidence of
postpartum haemorrhage
and the need for transfusion}Aboubakr Elnashar
49. 7 Risk of fetal lacerations is
about 2%.
8 Forceps should only be
used if there is difficulty
delivering the baby’s head.
{The effect on neonatal morbidity
of the routine use of forceps
remains uncertain}.Aboubakr Elnashar
50. 9 Oxytocin 5 IU by
slow IVI {encourage
contraction of the
uterus and to
decrease blood loss}.
Aboubakr Elnashar
51. 10 placenta should be
removed using
controlled cord traction
and not manual
removal {reduces the
risk of endometritis}.
Aboubakr Elnashar
52. 11 Intraperitoneal repair of the
uterus at CS should be
undertaken.
Exteriorisation of the uterus is
not recommended {more pain
and does not improve operative
outcomes such as haemorrhage
and infection}.
Aboubakr Elnashar
53. 12 {The effectiveness and
safety of single layer
closure of the uterine
incision is uncertain}. The
uterine incision should
be sutured with two
layers. Aboubakr Elnashar
54. 13 Neither the visceral nor
the parietal peritoneum
should be sutured {reduces
operating time and the need
for postoperative analgesia,
and improves maternal
satisfaction}.
Aboubakr Elnashar
55. 14 In the rare circumstances
that a midline abdominal
incision is used, mass
closure with slowly
absorbable continuous
sutures {fewer incisional
hernias and less dehiscence
than layered closure}.Aboubakr Elnashar
56. 15 Routine closure of the
subcutaneous tissue space
should not be used, unless
the woman has more than
2 cm subcutaneous fat,
{does not reduce the
incidence of wound
infection}. Aboubakr Elnashar
57. 16 Superficial wound
drains should not be
used {do not decrease
the incidence of wound
infection or wound
haematoma}.
Aboubakr Elnashar
58. 17 Umbilical artery pH
should be performed
after all CS for
suspected fetal
compromise {review of
fetal wellbeing and guide
ongoing care of the baby}.Aboubakr Elnashar
59. 18 Prophylactic antibiotics (a
single dose of first-
generation cephalosporin or
ampicillin {reduce the risk of
postoperative infections (such as
endometritis, urinary tract and
wound infection which occur in
about 8%}
Aboubakr Elnashar
60. 19 Women having a CS should be
offered thromboprophylaxis {they
are at increased risk of venous
thromboembolism}.
The choice of method of
prophylaxis (graduated stockings,
hydration, early mobilisation, low
molecular weight heparin) should
take into account risk of
thromboembolic diseaseAboubakr Elnashar
61. 20 Women’s preferences for
the birth (music playing in
theatre, lowering the screen
to see the baby born, or
silence so that the mother’s
voice is the first the baby
hears) should be
accommodatedAboubakr Elnashar
63. 1 Regional anaesthesia
•Safer
•less maternal & neonatal
morbidity than general
anaesthesia.
•This includes women who
have a diagnosis of placenta
praevia. Aboubakr Elnashar
64. 2 Regional anaesthesia
. in theatre {does not
increase patient anxiety}.
. IV ephedrine or phenylephrine,
. volume pre-loading with
crystalloid or colloid {reduce
the risk of hypotension}
Aboubakr Elnashar
65. 5 Each maternity unit should have a
drill for failed intubation during
obstetric anaesthesia.
6 {reduce the risk of aspiration
pneumonitis}
antacids and
drugs (H2 receptor antagonists or
proton pump inhibitors) {reduce
gastric volumes and acidity before
CS}. Aboubakr Elnashar
66. 7 Antiemetics (either
pharmacological or acupressure)
{reduce nausea and vomiting
during CS}.
8 General anaesthesia for
emergency CS should include
preoxygenation, cricoid pressure
and rapid sequence induction
{reduce the risk of aspiration}.Aboubakr Elnashar
67. 9 IV ephedrine or
phenylephrine should be
used in the management of
hypotension during CS.
10 The operating table
should have a lateral tilt of
15° {reduces maternal
hypotension}.Aboubakr Elnashar
69. 1 An appropriately trained practitioner
skilled in the resuscitation of the
newborn should be present at CS
performed under general anaesthesia
or where there is evidence of fetal
compromise.
2 Babies born by CS are more likely to
have a lower temperature, and thermal
care should be in accordance with good
practice for thermal care of the
newborn baby. Aboubakr Elnashar
70. 3 Early skin-to-skin contact
between the woman and her
baby should be encouraged and
facilitated because it improves
maternal perceptions of the
infant, mothering skills, maternal
behaviour, and breastfeeding
outcomes, and reduces infant
crying. Aboubakr Elnashar
71. 4 Women who have had a CS should
be offered additional support to help
them to start breastfeeding as soon as
possible after the birth of their baby.
This is because women who have had
a CS are less likely to start
breastfeeding in the first few hours after
the birth, but, when breastfeeding is
established, they are as likely to
continue as women who have a vaginal
birth. Aboubakr Elnashar
73. 1 After CS, women should be observed on a
one-to-one basis by a properly trained
member of staff until they have regained
airway control and cardiorespiratory stability
and are able to communicate.
2 Healthcare professionals caring for
women after CS should be aware that,
although it is rare for women to need
intensive care following childbirth, this
occurs more frequently after CS (about 9
per 1000).
Aboubakr Elnashar
74. 3 After recovery from anaesthesia,
observations (respiratory rate, heart
rate, blood pressure, pain and
sedation) should be continued every
half hour for 2 hours, and hourly
thereafter provided that the
observations are stable or satisfactory.
If these observations are not stable,
more frequent observations and
medical review are recommended.
Aboubakr Elnashar
75. 4 For women who have had intrathecal
opioids, there should be a minimum hourly
observation of respiratory rate, sedation and
pain scores for at least 12 hours for
diamorphine and 24 hours for morphine.
5 For women who have epidural opioids or
patientcontrolled analgesia with opioids,
there should be routine hourly monitoring of
respiratory rate, sedation and pain scores
throughout treatment and for at least 2
hours after discontinuation of treatment.
Aboubakr Elnashar
76. 6 Women should be offered
diamorphine (0.3–0.4 mg intrathecally)
for intra- and postoperative analgesia
because it reduces the need for
supplemental analgesia after a CS.
Epidural diamorphine (2.5–5 mg) is a
suitable alternative.
7 Patient-controlled analgesia using
opioid analgesics should be offered
after CS because it improves pain
relief. Aboubakr Elnashar
77. 8 Providing there is no
contraindication, non-steroidal anti-
inflammatory drugs should be
offered post-CS as an adjunct to
other analgesics, because they
reduce the need for opioids.
9 Women who are recovering well
after CS and do not have
complications can eat and drink
when they feel hungry or thirsty.Aboubakr Elnashar
78. 10 Removal of the urinary bladder catheter
should be carried out once a woman is
mobile after a regional anaesthetic and not
sooner than 12 hours after the last ‘top up’
dose.
11 Routine respiratory physiotherapy does
not need to be offered to women after a CS
under general anaesthesia, because it does
not improve respiratory outcomes such as
coughing, phlegm, body temperature, chest
palpation and auscultatory changes.
Aboubakr Elnashar
79. 12 Length of hospital stay is likely to be
longer after a CS (an average of 3–4
days) than after a vaginal birth
(average 1–2 days). However, women
who are recovering well, are apyrexial
and do not have complications
following CS should be offered early
discharge (after 24 hours) from hospital
and follow-up at home, because this is
not associated with more infant or
maternal readmissions.Aboubakr Elnashar
81. 1 In addition to general postnatal
care, women who have had a
CS should be provided with:
• specific care related to
recovery after CS
• care related to management of
other complications during
pregnancy or childbirth.
Aboubakr Elnashar
82. 2 Women who have a CS should
be prescribed and encouraged
to take regular analgesia for
postoperative pain, using:
• for severe pain, co-codamol
with added ibuprofen
• for moderate pain, co-codamol
• for mild pain, paracetamol.
Aboubakr Elnashar
83. 3 CS wound care should include:
• removing the dressing 24 hours after the
CS
• specific monitoring for fever
• assessing the wound for signs of infection
(such as increasing pain, redness or
discharge), separation or dehiscence
• encouraging the woman to wear loose,
comfortable clothes and cotton underwear
• gently cleaning and drying the wound daily
• if needed, planning the removal of sutures
or clips. Aboubakr Elnashar
84. 4 Urinary symptoms: consider
the possible diagnosis of:
• urinary tract infection
• stress incontinence (occurs in
about 4% of women after CS)
• urinary tract injury (occurs in
about 1 per 1000 CS).
Aboubakr Elnashar
85. 5 Irregular vaginal
bleeding should
consider that this is
more likely to be due to
endometritis than
retained products of
Aboubakr Elnashar
86. 6 Women who have had a CS are
at increased risk of thromboembolic
disease (both deep vein thrombosis
and pulmonary embolism), so
healthcare professionals need to
pay particular attention to women
who have chest symptoms (such as
cough or shortness of breath) or leg
symptoms (such as painful swollen
calf). Aboubakr Elnashar
87. 7 Women who have had a CS
should resume activities such as
driving a vehicle, carrying heavy
items, formal exercise and
sexual intercourse once they
have fully recovered from the CS
(including any physical
restrictions or distracting effect
due to pain). Aboubakr Elnashar
88. 8 After a CS:
No increased risk of
difficulties with breastfeeding,
depression, post-traumatic
stress symptoms,
dyspareunia and faecal
incontinence.
Aboubakr Elnashar
90. 1 {The risks and benefits of vaginal
birth after CS compared with repeat CS
are uncertain}. Therefore the decision
about mode of birth after a previous CS
should take into consideration:
• maternal preferences and priorities
• a general discussion of the overall
risks and benefits of CS
• risk of uterine rupture
• risk of perinatal mortality and
morbidity. Aboubakr Elnashar
91. 2 Pregnant women who have a
previous CS and who want to have a
vaginal birth should be supported in this
decision. They should be informed that:
• uterine rupture is a very rare
complication, but is
increased in women having a planned
vaginal birth(35 per 10,000 women
compared with 12 per 10,000 women
having planned repeat CS)
Aboubakr Elnashar
92. • the risk of an intrapartum infant
death is small for women who
have a planned vaginal birth
(about 10 per 10,000), but higher
than for a planned repeat CS
(about 1 per 10,000)
• the effect of planned vaginal
birth or planned repeat CS on
cerebral palsy is uncertain.Aboubakr Elnashar
93. 3 Women who have had a
previous CS should be offered:
• electronic fetal monitoring
during labour
• care during labour in a unit
where there is immediate
access to CS and on-site blood
transfusion services.
Aboubakr Elnashar
94. 4 Women who have had a previous
CS can be offered induction of
labour, but be aware that the
likelihood of uterine rupture in these
circumstances is increased to:
• 80 per 10,000 when labour is
induced with nonprostaglandin
agents
• 240 per 10,000 when labour is
induced using prostaglandins.Aboubakr Elnashar
95. 5 During induction of labour,
women who have had a
previous CS should be
monitored closely, with
access to electronic fetal
monitoring and with
immediate access to CS
{increased risk of uterine rupture}.Aboubakr Elnashar
96. 6 Pregnant women with both
previous CS and a previous
vaginal birth should be
informed that they have an
increased likelihood of a
vaginal birth than women
who have had a previous CS
but no previous vaginal birth.Aboubakr Elnashar