In European women breech delivery
can be considered as they have broader
hips than Africans however another
study showed poor outcomes in
the baby even in successful breech
deliveries hence the strategy to either
have an External Cephalic Version
(ECV) at about 36-38 weeks of
pregnancy also associated with some
risks or an Elective Caeserean Section
for breech presentation.
The most common being placenta
praevia (placenta ahead of the baby
and may block entire cervix); Placenta
abruption (shearing off of the placenta
from the uterine wall) trauma with
subsequent abruption and please note
sexual activity could be considered
trauma and rarer presentations such
as uterine rupture (this is when the
uterine muscle gives way and an
opening is created in the uterus).
The Term Breech Trial clearly
demonstrates that planned caesarean
section in women presenting at term
in their first pregnancy with a breech
presentation has a lower risk of infant
death than planned vaginal breech
delivery. In transvers lie an ECV can
also be contemplated. It is not possible
to deliver a transverse lie unless the
baby is unfortunately dead and is very
pre-term/small.
Velamentous insertion of the cord
(when the umbilical cord inserts
itself at the edge of the placenta and
not its normal central location in the
placenta) and a vasa previa, when
the blood vessels travel through the
portion of the amniotioc sac that is
presenting or in the cervical canal may
also be other causes of bleeding in
pregnancy.
One of the obstetric complications
that’s very dramatic is a cord prolapse
and this is something that God forbid
should never happen to anyone. If
diagnosed swiftly and the cord is still
pulsating i.e. the baby is still alive, it
requires prompt performance of a CS
for a good outcome for the baby. The
C/S in this case is purely for the baby’s
benefit, but hey why are we pregnant
in the first place.
It is very rewarding to do a CS for a
cord prolapse and have a successful
outcome, sadly however this is not
always the case. This is one of the
reasons why drainage of liquour is
considered a danger sign in pregnancy.
So should any of you be expecting and
your water breaks report promptly to
your healthcare provider and not the
clinic but the hospital you intend to
deliver in.
Bleeding is another danger sign
but fortunately one any reasonable
thinking person would feel is
abnormal and report to their doctor as
soon as it happens. Bleeding beyond
20 weeks of pregnancy can be due to
several reasons.
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Uterine rupture or impending rupture
may not necessarily present with
bleeding but any sign of rupture or
imminent rupture will definitely be
an emergency and land the mother in
theater for an operation.
An increase or decrease in the babies
heart rate what we call foetal distress
or a non reasurrig fetal heart tracing if
an electronic foetal monitor is placed
are other common reasons for an
emergency CS.
Induction of labor is done for various
reasons and one of the complication is
a failed induction. Should this occur
the only resort is to deliver the baby
via Caeserean section.
A failed instrumental delivery (by
forceps or ventouse/vacuum) when
this is unsuccessful, the baby will need
to be born by caesarean section.
CS can also be necessitated by other
complications of pregnancy, preexisting conditions and concomitant
disease, such as:
pPre-eclampsia or hypertension in
pregnancy: this is when blood
pressure is elevated in pregnancy
and usually depending on the
severity of the disease delivery
can be contemplated very early
and in severely premature infants a
vaginal delivery will result in poorer
outcomes. Also due to complications
of the disease such as eclampsia:
case where mother gets epileptic like
fits due to the disease delivery has to
be conducted within a specific time
period and in some circumstances a
CS is the best solution.
p High risk fetus: in the advent of
IVF, and mothers with recurrent
late pregnancy losses or fetuses
with congenital abnormalities or
who are compromised (growth
restricted or with poor blood flow
in the placental bed) a caesarean
section can be contemplated.
p HIV infection: Pregnant women
with a high viral load should have
an elective Caesereen delivery to
help reduce the chances of
transmission to their babies. (HIV
with a low maternal viral load is
not necessarily an indication for
caesarean section).
p Sexually Transmitted Diseases,
such as a first outbreak of genital
herpes very recently before the
onset of labor (which can cause
infection in the baby if the baby is
born vaginally) calls for a CS.
p Previous Caesarean section
especially with recurrent causes
such as CPD mentioned earlier
will warrant an elective repeat
Caeserean Section.
p Anyone with a history of a previous
uterine rupture will not be allowed
to attempt a vaginal delivery and
lucky her that we are more
conservative in management as
previously this would be a sentence
for removal of the uterus.
p Prior problems with the healing
of the perineum (from previous
childbirth or Crohn’s disease)