Cesarean Section

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS

Maternal Indications

  • Trial of labor that fails, is not tolerated, or is not indicated
  • Antepartum hemorrhage or bleeding disorder
  • Pelvic or uterine abnormality
  • Placental abnormality
  • Severe hypertension or severe preeclampsia
  • Active maternal herpes simplex genital infection

Fetal Indications

  • Malpresentation
  • Arrest of descent
  • Failed trial of forceps or vacuum
  • Fetal distress
  • Fetal anomalies or very low or very high birthweight
  • Cord prolapse
  • Multiple gestation or twins with first being nonvertex
  • Perimortem
  • Maternal HIV infection
CONTRAINDICATIONS
  • Patient refusal of operation with clear consequences explained and accepted
EQUIPMENT

Standard operating room cesarean section package to include the following:

QuantityInstrument
2Babcock clamps (if tubal ligation planned)
6Allis clamps
4Pennington clamps (8 inch)
2Tissue forceps (toothed) (6 and 8 inch)
2Dressing forceps (smooth) (6 and 8 inch)
2Russian forceps (6 and 8 inch)
4Sponge forceps
2Adson forceps with teeth
2No. 20 blade
1No. 10 blade
6Curved hemostats (5½ inch)
6Curved Kelly clamps
2Needle holder
4Kocher or Ochsner clamps (7½ inch)
2Army-Navy retractor
1DeLee, Fritsch, or Rochard universal retractor
3Richardson retractor (small, medium, and large)
1Bandage scissors (7½ inch)
1Metzenbaum scissors (7 inch)
1Curved Mayo scissors (6½ inch)
1Suture scissors
1Straight Mayo scissors (6½ inch)
1Poole suction tip
1Yankauer tonsil suction tip
4Packages of suture (two packages each of 0 chromic and 1-0 Vicryl)
20Lap sponges
1Surgical stapler
1Bovie cautery device
1Cervical dilators

ANATOMY

Bladder

  • The ureters enter the pelvis deep to the peritoneum and then turn medially with the nerves and vessels of the uterus at the base of the broad ligament.

Uterus

  • The uterine blood vessels run at the base of the broad ligaments.

Abdominal Wall (Inferior to the Arcuate Line)

  • Immediately beneath the skin is a fatty layer that overlies the anterior layers of the rectus sheath and the aponeurosis of the abdominal oblique muscles.
  • The transversalis fascia lies beneath the rectus abdominis. At the midline, the umbilical prevesical fascia is present, along with the urachus. A fatty layer separates the transversalis fascia (or the umbilical prevesical fascia) from the peritoneum.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE

Table 3 shows typical postoperative orders for cesarean section.

Post-procedure Patient Education

First 24 Hours

  • Advise the patient of what to expect and about pain management.
  • Keep the Foley catheter in place.
  • Advise early breastfeeding and bonding.

First Postoperative Day

  • The patient should ambulate to prevent atelectasis and pneumonia.
  • If bowel sounds are present, advance the diet.
  • If the patient is ambulating well, remove the Foley catheter.
  • Change the IV to a heparin lock.
  • Oral narcotic analgesia can replace PCA pump, IV, or IM narcotics.

Second Postoperative Day

  • Many patients can be discharged 36 hours after a cesarean section.
  • If the skin incision has closed, the staples can be removed and replaced with Steri-Strips.

Discharge Instructions for the Patient

  • No driving for 10 days.
  • Refrain from intercourse for 4 to 6 weeks.
  • Water can wash over the wound as long as water has no direct impact on the wound. Keep the wound clean and dry.
  • Notify the physician's office of the following problems: Pus seeping out of the wound, fever, painful urination, difficulty breathing, shortness of breath, or increasing pain.
  • Follow up in the office for a wound check in 1 week.
  • Limit activity to walking for the first week, back to full activity by 6 weeks.
COMPLICATIONS
  • Complications associated with anesthesia
  • Injury to the bladder or ureters
  • Injury to the bowel
  • Uterine hemorrhage
  • Infection: Endometritis, urinary tract infection, respiratory infection, atelectasis, wound infection, septic pelvic thrombophlebitis
  • Pulmonary embolism
  • Risk of rupture in future deliveries
  • Injury to the child
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