Prevention of Sacral Cautery Burns During Lower Segment Caesarean Section
To prevent sacral cautery burns during LSCS, place the electrosurgical grounding pad on the patient's thigh or upper extremity (shoulder/arm), never on the sacral area, and use bipolar cautery whenever possible to minimize stray current transmission. 1
Critical Grounding Pad Placement
The grounding pad must be positioned on the patient's leg or right shoulder/arm to prevent electrical current conduction through sensitive areas. This placement creates a safe pathway for dispersive electrode current away from the sacrum and prevents burns in pressure-contact areas. 1
During pregnancy and cesarean delivery, the grounding pad should specifically avoid placement near the sacral region, as this area is at high risk for pressure injury and has increased susceptibility to thermal damage from prolonged contact and electrical current flow. 1
Preferred Cautery Technique
Bipolar electrosurgery is strongly preferred over monopolar cautery during LSCS, as bipolar current flows only between the two tips of the forceps and does not travel through the patient's body to a grounding pad. This eliminates the risk of stray current burns at distant sites including the sacrum. 1
If monopolar cautery must be used, ensure the lowest effective power settings to minimize thermal spread and reduce the risk of capacitive coupling or insulation failure that could cause unintended burns. 1, 2
Patient Positioning Considerations
Position the patient in left pelvic tilt or left lateral decubitus position during cesarean delivery to minimize aortocaval compression. This positioning also reduces prolonged pressure on the sacrum, which when combined with electrical current from improperly placed grounding pads, significantly increases burn risk. 1
Avoid supine positioning after 20 weeks gestation, as this increases sacral pressure and compounds the risk of thermal injury if the grounding pad is placed posteriorly. 1
Additional Safety Measures
Inspect all electrosurgical instruments for insulation integrity before use, as insulation failure can cause capacitive coupling and stray energy burns at trocar sites or contact points including the sacrum. 3, 4
Use the lowest effective electrosurgical power settings (avoid high-voltage coagulation mode >40W when possible) to minimize the risk of unintended thermal injury through direct coupling, insulation failure, or capacitive coupling. 2
Ensure adequate padding of all pressure points including the sacrum, as areas under pressure are more vulnerable to thermal injury from electrical current. 1
Common Pitfalls to Avoid
Never place the grounding pad on or near the sacral area during cesarean delivery, as this creates a direct pathway for electrical current through an area already at risk for pressure injury and thermal damage. 1
Avoid creating open circuits during electrosurgical use, as this significantly increases capacitive coupling and the risk of trocar-site or contact-point burns (impedance reduction from 142.0 Ω to 109.3 Ω with open circuits, p=0.040). 4
Do not use monopolar cautery when bipolar alternatives are available, as monopolar current requires body-wide current flow that increases burn risk at the grounding pad site and other contact points. 1