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17 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Risk involved in pregnancy after cs |
1. Scar rupture 2. Adherant placenta 3. Operative Interference 4. Peripartum hysterectomy |
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How is scar dehiscence different from scar rupture? |
Separation of scar with intact serosa and no expulsion of intrauterine contents |
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Problems in repeat CS |
1. Adhesions- difficulty 2. Injury to bladder/bowel 3. PPH d/t placenta previa or adherant placenta 4. Caeserian hysterectomy |
4 |
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Time of admission |
Classical cs 34w Lscs 38w |
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Mx options |
Elective cs TOLAC |
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Elective cs timing |
If maturity + then 39w+ On onset of spontaneous labour. If prior to 39w then antenatal corticosteroids given |
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TOLAC case selection - Prev. History |
1. Incision- LSCS 2. Prior Indication- non-recurring 3. Prior vaginal delivery 4. No post op infections 5. Interpreg interval >6m |
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TOLAC case selection- Current pregnancy |
1. Pt preference 2. No med or obs complication 3. Avg size baby 4. Vertex presentation 5. No CPD |
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Monitoring ip in vbac |
1. Arrange blood 2. Maternal pulse and BP 3. Continuous CTG 4. Check progress Induction--> best avoided, used with caution Prolonged labour--> best to terminate with EmCS |
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TOLAC case selection- labour |
1. Institutional delivery 2. Continuous ctg monitoring 3. Spontaneous onset of labour 4. Emergency CS facility 5. Blood bank facility |
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Delivery in vbac |
A. 2nd stage- vacuum/forceps B. 3rd stage- look for signs of scar rupture C. Bleeding excessive--> Em laparotomy and Tear repair or hysterectomy. D. 4-6 h observation. |
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Mx of vbac headings |
1. Informed consent 2. Monitoring 3. Indications for emergency CS 4. Delivery 5. IUD |
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IUD |
Augment labour with mifepristone oral 600mg odx 2D or 200mg TDSx 2D |
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C/I to VBAC |
Prev. Classical CS Prev. 2 LSCS Prev. Inverted T incision Prev. Low vertical incision extended upward Malpresentations Cpd suspected Multiple pregnany Med or obs complications Pt. Refusal |
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10 Signs of scar dehiscence |
1. Loss of uterine contour 2. Change in CTG (earliest sign) 3. Persistent maternal tachycardia 4. Feeling of giving away 5. Cessation of uterine activity 6. A/c scar tenderness 7. Shoulder pain 8. Vaginal bleeding 9. Blood stained urine 10. Meconium staining of AF |
10 |
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Place of ultrasound in tolac |
1. Integrity of the scar 3.5mm or more...low risk of rupture. 2. Assessing placental location 3. To diagnose adherant placenta
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Adherant placenta on usg |
1. Retroplacental sonolucent layer absent 2. Large placental vascular lakes 3. Thinning of interface b/w uterine serosa and bladder 4. Doppler- lacunar flow in the placenta that extends into surrounding tissues. |
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