From the Guidelines
Caesarean sections should be performed with adherence to guidelines that prioritize the administration of prophylactic antibiotics within 60 minutes before the skin incision, the use of regional anesthesia, and the implementation of measures to prevent intraoperative hypothermia, as these practices have been shown to reduce postoperative infections and improve maternal and neonatal outcomes. When considering the guidelines for caesarean sections, several key elements must be taken into account to ensure the best possible outcomes for both the mother and the baby.
Preoperative Preparation
- Administering intravenous antibiotics, such as a first-generation cephalosporin, within 60 minutes before the cesarean delivery skin incision is recommended, with the addition of azithromycin in women in labor or with ruptured membranes, as supported by high-level evidence 1.
- Chlorhexidine-alcohol is preferred over aqueous povidone-iodine solution for abdominal skin cleansing before cesarean delivery, based on high-level evidence 1.
Intraoperative Care
- Regional anesthesia is the preferred method of anesthesia for cesarean delivery as part of an enhanced recovery protocol, although the evidence level for this recommendation is low 1.
- Measures to prevent intraoperative hypothermia, including forced air warming, intravenous fluid warming, and increasing operating room temperature, are recommended, with a low evidence level but a strong recommendation grade 1.
Surgical Techniques
- Blunt expansion of a transverse uterine hysterotomy at the time of cesarean delivery is recommended to reduce surgical blood loss, with moderate-level evidence 1.
- Closure of the hysterotomy in 2 layers may be associated with a lower rate of uterine rupture, although the evidence level for this is moderate and the recommendation grade is weak 1.
Postoperative Care
- Early mobilization and adequate pain management using a multimodal approach are crucial for a smooth recovery, although specific details on these aspects are not provided in the referenced study 1. By following these guidelines, healthcare providers can minimize maternal and neonatal morbidity and ensure safe delivery when vaginal birth is not appropriate or possible.
From the Research
Clinical Guidelines for Caesarean Sections
- The optimal timing of caesarean delivery concerning fetal and maternal benefits is still unclear, particularly in cases of placenta previa and placenta accreta spectrum (PAS) 2.
- Maternal complication rates are increased in women who are operated on emergency conditions due to placenta previa, and perinatal outcomes are better in women who underwent planned surgery and in those with gestational age greater than 37 weeks 2.
- The use of regional anaesthesia for caesarean section in women with placenta previa is associated with less blood loss, need for blood transfusion, and better maternal and neonatal outcomes compared to general anaesthesia 3.
Factors Influencing Caesarean Section Use
- The increasing rate of caesarean section is a global concern, and interventions to reduce unnecessary caesarean sections have shown little success 4.
- Factors associated with caesarean section use include women's, families', health professionals', and health-care organisations' and systems' factors, as well as behavioural, psychosocial, health system, and financial factors 4.
- Clinical interventions, such as external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after caesarean section, could reduce the frequency of caesarean section use 4.
Specific Considerations for Caesarean Delivery on Maternal Request
- Cesarean delivery on maternal request is not a well-recognized clinical entity, and the available information does not provide the basis for a recommendation for either mode of delivery 5.
- When a woman desires a cesarean delivery on maternal request, her health care provider should consider her specific risk factors, such as age, body mass index, accuracy of estimated gestational age, reproductive plans, personal values, and cultural context 5.
- In the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended 5.