Post-Operative Care Recommendations for Cesarean Section Patients
Patients who have undergone cesarean section should receive multimodal analgesia, early oral intake within 2 hours of surgery, early mobilization, and immediate removal of urinary catheters to optimize recovery and reduce complications. 1
Pain Management
- Implement multimodal analgesia approach:
- Regular scheduled non-steroidal anti-inflammatory drugs (NSAIDs)
- Regular paracetamol (acetaminophen)
- Minimize opioid use to reduce side effects 1
- This combination is cost-effective, easy to administer, and promotes faster recovery by reducing opioid-related complications
Nutrition and Hydration
- Initiate regular diet within 2 hours after cesarean delivery 1
- Benefits of early feeding (high-quality evidence, strong recommendation):
- Reduced thirst and hunger
- Improved maternal satisfaction
- Earlier ambulation
- Shorter hospital stay
- No increase in complications 1
- Diet should include adequate fiber to prevent constipation and support breastfeeding with sufficient calories, milk, fruits, and vegetables
Mobilization
- Encourage early mobilization as soon as possible after surgery 1
- Early ambulation helps prevent:
- Thromboembolic complications
- Respiratory issues
- Constipation
- Prolonged hospital stays
Urinary Catheter Management
- Remove urinary catheter immediately after cesarean delivery 1
- Benefits of immediate removal:
- Lower incidence of urinary tract infections
- Reduced urethral pain and difficult voiding
- Shorter ambulation time
- Shorter hospital stay
Thromboembolism Prophylaxis
- Use pneumatic compression stockings during and after surgery 1
- Consider risk stratification for pharmacologic prophylaxis
- Early mobilization is an important component of thromboprophylaxis
Glucose Control
- Monitor and maintain tight control of capillary blood glucose levels 1
- Particularly important for patients with diabetes or gestational diabetes
- Helps reduce surgical site infections and other complications
Wound Care and Infection Prevention
- Monitor incision site for signs of infection
- Chlorhexidine-alcohol is the preferred skin preparation before cesarean delivery 1, 2
- Vaginal preparation with povidone-iodine solution should be considered for infection reduction 1, 2
- Prophylactic antibiotics should have been administered within 60 minutes before skin incision 2
Nausea and Vomiting Management
- Use multimodal approach for prevention and treatment 1
- Effective interventions include:
- Fluid preloading
- Administration of ephedrine or phenylephrine
- Lower limb compression
- Antiemetic agents as needed
Discharge Planning
- Consider discharge as early as 24 hours post-surgery if the patient meets these criteria 3:
- Good general condition
- Stable vital signs
- No underlying medical problems
- Adequate pain control
- No signs of complications
- Provide standardized written discharge instructions 1
Follow-up Recommendations
- Schedule follow-up appointment within 1-2 weeks
- Instruct patient to monitor for warning signs requiring immediate attention:
- Fever
- Increasing pain
- Wound drainage or separation
- Heavy vaginal bleeding
- Signs of thromboembolism (leg pain, swelling, shortness of breath)
Common Complications to Monitor
- Surgical site infections (most common post-operative complication) 4
- Urinary tract infections 4
- Postpartum hemorrhage
- Endometritis
- Thromboembolic events
Early detection of complications through appropriate monitoring can significantly improve outcomes and reduce morbidity following cesarean delivery.