Guidelines for perioperative care of women who deliver by CD

  • Am J Obstet Gynecol

  • Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • The Enhanced Recovery After Surgery (ERAS) process has been applied to obstetrical care and yielded recommendations for perioperative care for cesarean delivery (CD).

Why this matters

  • ERAS is a standardized, perioperative care program that is embedded in a number of surgical specialties and has been shown to improve clinical outcomes.

Key results

  • To prevent postoperative infections:
    • CD performed before rupture of membranes (ROM) and chorioamnionitis is considered a clean/class I incision; narrow-spectrum, first-generation cephalosporin is recommended 30-60 minutes before incision.
    • A CD with ROM in labor or with chorioamnionitis is considered a clean contaminated/class II incision; broaden antibiotic coverage by adding azithromycin.
    • Prior to admission, suggest bathing with antimicrobial soap.
    • Preoperative chlorhexidine-alcohol scrub is preferred.
    • Vaginal prep should be considered with ROM/labor.
  • Anesthesia:
    • Regional anesthesia is preferred.
  • Prevention of hypothermia:
    • Appropriate monitoring.
    • Forced air warming.
    • Increasing operating room temperatures.
  • Surgical techniques/issues:
    • Blunt expansion of uterine incision.
    • Closure of uterine incision in 2 layers may reduce risk for future uterine rupture.
    • Peritoneum does not need to be closed.
    • Skin should be closed with subcuticular suture.
    • If subcutaneous layer >2 cm, reapproximation of this layer should be performed.
  • Neonatal concerns:
    • Delayed cord clamping x 60 seconds.
    • Routine suctioning should be avoided.

Study design

  • Literature search and expert commentary.
  • Quality assessment of each article.
  • Funding: None.

Limitations

  • Recommendations may change.