Cesarean Section Birth and Postpartum Complications

Comprehensive vocabulary flashcards covering indications, classifications, surgical procedures, preoperative protocols, and postpartum complications related to cesarean section births and postpartum hemorrhage.

Cesarean Birth

A surgical procedure where the infant is delivered through an incision in the abdomen, performed under a 'racing the clock' standard of $30\,\text{minutes}$ from decision to incision.

Emergent Cesarean Birth

A classification of cesarean delivery indicating an immediate need for delivery due to critical life-threatening conditions such as cord prolapse, placental abruption, placenta previa with significant bleeding, or category $3$ fetal heart rate.

Urgent Cesarean Birth

A classification of cesarean delivery indicating a need for rapid delivery due to complications such as malposition discovered after the start of labor or placenta previa with mild bleeding.

Non-urgent Cesarean Birth

A cesarean delivery classification indicated for complications that require surgical delivery but are not emergencies, such as failure to dilate or descend.

Trial of Labor After Cesarean (TOLAC)

An attempt to undergo labor and deliver vaginally after having had a previous cesarean section.

Vaginal Birth After Cesarean (VBAC)

A successful vaginal birth following a prior cesarean delivery, which poses a higher risk to the mother and baby due to the uterine scar, limited ability to induce labor, and risk of uterine rupture.

Placenta Accreta

An abnormal placentation condition associated with repeat surgical births where the placenta abnormally attaches directly to the uterine wall.

Placenta Percreta

The most invasive form of abnormal placentation where the placenta attaches completely through the uterine muscular wall and invades into the peritoneum.

Preoperative IV Fluid Bolus

An infusion of $500\text{ to }1{,}000\,\text{mL}$ of IV fluids administered via an $18\text{G}$ IV catheter prior to spinal or epidural anesthesia to increase circulating volume and decrease the risk of hypotension caused by anesthetic agents.

Spinal Block vs. Epidural Block

Regional anesthesia techniques used in cesarean births; a spinal block penetrates the dura mater into the subarachnoid space below the spinal cord termination, whereas an epidural block introduces medication into the epidural space outside the dura mater.

Pfannenstiel Incision

A lower transverse skin incision, also referred to as a 'bikini cut,' consisting of a low, horizontal incision across the abdomen and uterus.

Classical Incision

A cesarean section technique involving a vertical cut through the abdominal wall and the uterus.

Cesarean Section Incision Types

Surgical entries utilized during cesarean delivery, categorized into transverse Pfannenstiel skin incision, vertical abdominal wall skin incision, low transverse uterine incision, and classic vertical uterine incision.

Severe Maternal Morbidity

Unexpected labor and delivery outcomes resulting in significant short- or long-term health consequences to a woman, which have seen a $75\%$ increase over the last $10\,\text{years}$.

Postpartum Hemorrhage (PPH)

Excessive blood loss typically defined as blood loss $>1{,}000\,\text{mL}$ for vaginal or cesarean deliveries, and/or a $>10\%$ decrease in hemoglobin or hematocrit for cesarean sections.

Primary Postpartum Hemorrhage

Early postpartum hemorrhage occurring within the first $24\,\text{hours}$ after birth, with the highest risk taking place within the first hour.

The 4 Ts of PPH Etiology

A diagnostic framework identifying the primary causes of postpartum hemorrhage: Tonus (uterine atony, $70\%$), Trauma (laceration of the birth canal, $20\%$), Tissue (retained placental tissue, $10\%$), and Thrombin (acquired or preexisting coagulopathies, $1\%$).

Uterine Atony

Failure of the uterine myometrium to contract effectively following delivery, accounting for $70\%$ of postpartum hemorrhage cases and presenting with persistent bleeding and a boggy uterus.

Hypovolemic Shock

A life-threatening clinical state resulting from critical blood loss, marked by increasing pulse, hypotension, rapid breathing, pale appearance, cool clammy skin, reduced urine output, dizziness, restlessness, or altered mental status.

Massive Transfusion Protocol (MTP)

An emergency resuscitation protocol activated during severe obstetric hemorrhage that administers $2\text{ to }4\,\text{units}$ of uncrossmatched O-negative PRBCs if needed, followed by blood packs containing $6\,\text{units}$ of PRBCs, $4\,\text{units}$ of FFP, and $1\,\text{unit}$ of platelets to maintain a $6:4$ ratio.

Oxytocin (Pitocin)

A first-line uterotonic medication administered as $20\,\text{units}$ in $1\,\text{L}$ of normal saline or lactated Ringer's IV (or $10\,\text{units}$ IM) to stimulate uterine contractions, carrying no contraindications.

Methylergonovine (Methergine)

An ergot alkaloid uterotonic given PO ($200\text{ to }400\,\text{mcg}$ every $6\text{ to }12\,\text{hours}$) or IM ($200\,\text{mcg}$ every $2\text{ to }4\,\text{hours}$) to stimulate uterine contractions; contraindicated in patients with hypertension.

Carboprost-tromethamine (Hemabate)

A prostaglandin uterotonic agent given as an IM injection of $250\,\text{mcg}$ to stimulate uterine contractions; contraindicated in patients with asthma.

Misoprostol (Cytotec)

A synthetic prostaglandin administered PO or PR at doses of $200\text{ to }1{,}000\,\text{mcg}$ off-label to stimulate uterine contractions during postpartum hemorrhage, having no contraindications.

Tranexamic Acid (TXA)

An antifibrinolytic medication administered IV ($1\,\text{g}$ over $10\,\text{minutes}$) or PO ($1\,\text{g}$) to treat hemorrhage by preventing blood clot breakdown, carrying no contraindications.

Disseminated Intravascular Coagulation (DIC)

A severe coagulation disorder in which coagulation pathways are hyperstimulated, triggering simultaneous depletion of clotting factors, widespread clot breakdown, thrombosis, and profuse bleeding.

Anaphylactoid Syndrome of Pregnancy (AFE)

A rare, life-threatening obstetric emergency triggered by an inflammatory response shift that causes an inappropriate release of endogenous inflammatory mediators, resulting in acute lung injury, transient pulmonary hypertension, coagulopathy, and cardiopulmonary arrest.

Venous Thromboembolic Disease (VTE)

A condition involving thrombus formation in the deep veins of the extremities that can lead to pulmonary embolism, managed with anticoagulation therapy maintained at a PTT of $1.5\text{ to }2.5\,\text{times}$ control values.

Endometritis

An infection of the uterine lining that typically originates at the placental attachment site, representing the most common cause of postpartum fever and characterized by localized tenderness, purulent vaginal discharge, and malaise.

Mastitis

An inflammation or infection of lactating breast tissue, usually unilateral and localized to the upper outer quadrant, presenting with tenderness, warmth, swelling, fever, and malaise, managed with antibiotics and continued feeding.