cesarean section (C-section)
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Introduction
surgical procedure used to deliver an unborn fetus
Epidemiology
- 22% of singleton births in women without prior cesarean section
- 13% ub Utah vs 27% in Florida & Louisianna[4]
- regular audits of practices & feedback to clinicians leads to fewer cesareans without compromising maternal or newborn safety[7]
Indications
- high risk vaginal delivery
- prior C-section
Contraindications
- prolonged latent phase labor is not an indication
- > 20 hours in nulliparous women
- > 14 hours in multiparous women
Procedure
- incisions are made through a mother's abdomen (laparotomy) & uterus (hysterotomy) to deliver the unborn baby
- skin preparation with 2% chlorhexidine/70% isopropanol associated with fewer surgical site infections than use of 8.3% povidone-iodine/72.5% isopropanol[9]
- intravenous antibiotics, usually cefazolin, generally administered before skin incision[9][11][14]
- addition of azithromycin 500 mg IV further reduces risk of infection (RR=0.5)[11]
- oral cephalexin + metronidazole for 48 hours after surgery reduced infections in obese women[14]
Complications
- endometritis, surgical wound infections[11]
- 12% with cefazolin alone; 6% with addition of azithromycin[11]
- post-operative ileus (10-15%)[6]
- increased autism risk observed in children born by C-section (RR=1.15-1.21) is likely due to genetic or other factors & is not caused by method of delivery[8]
- opiates after cesarean section as a pathway to opiate abuse[13]
Management
- DVT prophylaxis indicated prior to C-section[2]
- most women with 1-2 uncomplicated low transverse caesarean sections, in an otherwise uncomplicated pregnancy at term & with no contraindications to vaginal birth, are candidates vaginal delivery[2][3]
- 60-80% of women who attempt a trial of labor after C-section achieve a successful vaginal birth[15]
- conditions that can make vaginal birth after C-section less likely include:
- advanced maternal age
- high body mass index
- high birth weight
- previous C-section because the cervix failed to dilate
- conditions that can make vaginal birth after C-section less likely include:
- obese women:
- consult anesthesiology early
- consider prophylaxis for venous thromboembolism[3]
- vaginal seeding (the practice of collecting a mother's vaginal fluid on a gauze swab and wiping it over her newborn's mouth, eyes, & skin shortly after cesarean birth) is not recommended*[10]
- betamethasone 12 mg IM 48 hours before delivery reduces risk of
- respiratory distress syndrome
- transient tachypnea of the newborn
- mechanical ventilation[12]
* Newborns may develop severe infections from exposure to vaginal commensals & pathogens[10]
More general terms
Additional terms
References
- ↑ Wikipedia: Caesarean section http://en.wikipedia.org/wiki/caesarean_section
- ↑ 2.0 2.1 2.2 American College of Obstetricians and Gynecologists Obstetrics & Gynecology practice bulletin (subscription required) August 31, 2011 cited in Journal Watch, Massachessetts Medical Society http://www.journalwatch.org
- ↑ 3.0 3.1 3.2 The American College of Obstetrics and Gynecology Committee on Obstetric Practice.
Number 549 Jan 2013 Obesity in Pregnancy http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Obesity_in_Pregnancy - ↑ 4.0 4.1 Osterman SK and Martin JA Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006-2012 National Vital Statistics Reports 63(1). Jan 23, 2014 http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_01.pdf
- ↑ American College of Obstetricians and Gynecologists (ACOG) Safe Prevention of the Primary Cesarean Delivery Obstetric Care Consensus. Number 1, March 2014 http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery
- ↑ 6.0 6.1 6.2 6.3 The NNT: Chewing Gum for Reducing Post-Caesarian Section Ileus. http://www.thennt.com/nnt/chewing-gum-for-reducing-post-caesarian-section-ileus/
Craciunas L, Sajid MS, Ahmed AS. Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta- analysis of randomised controlled trials. BJOG. 2014 Jun;121(7):793-9; discussion 799 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24628729 - ↑ 7.0 7.1 Chaillet N et al A Cluster-Randomized Trial to Reduce Cesarean Delivery Rates in Quebec. N Engl J Med 2015; 372:1710-1721. April 30, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25923551 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1407120
- ↑ 8.0 8.1 Curran EA et al Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder. A Population-Based Sibling Design Study. JAMA Psychiatry. Published online June 24, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26107922 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2323630
- ↑ 9.0 9.1 9.2 Tuuli MG, Liu J, Stout MJ, Martin S et al A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery. N Engl J Med. 2016 Feb 4. [Epub ahead of print] PMID: https://www.ncbi.nlm.nih.gov/pubmed/26844840
- ↑ 10.0 10.1 10.2 Cunnington AJ et al "Vaginal seeding" of infants born by caesarean section. BMJ 2016;352:i227 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26906151 <Internet> http://www.bmj.com/content/352/bmj.i227
- ↑ 11.0 11.1 11.2 11.3 11.4 Tita AT, Szychowski JM, Boggess K et al Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med 2016; 375:1231-1241. September 29, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27682034 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1602044
Weinstein RA, Boyer KM Antibiotic Prophylaxis for Cesarean Delivery - When Broader Is Better. N Engl J Med 2016; 375:1284-1286. September 29, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27682038 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1610010 - ↑ 12.0 12.1 Saccone G, Berghella V Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ 2016;355:i5044 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27733360 <Internet> http://www.bmj.com/content/355/bmj.i5044
- ↑ 13.0 13.1 Osmundson SS, Schornack LA, Grasch JL et al. Postdischarge opioid use after cesarean delivery. Obstet Gynecol. 2017 Jul;130(1):36-41 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28594766
Bateman BT, Cole NM, Maeda A et al. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017 Jul;130(1):29-35 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28594763
Prabhu M, McQuaid-Hanson E, Hopp S et al. A shared decision-making intervention to guide opioid prescribing after cesarean delivery. Obstet Gynecol. 2017 Jul;130(1):42-46 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28594762 - ↑ 14.0 14.1 14.2 Valent AM, DeArmond C, Houston JM et al Effect of Post-Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women. A Randomized Clinical Trial. JAMA. 2017;318(11):1026-1034 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975304 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2654382
Calfee DP, Grunebaum A. Postoperative Antimicrobial Prophylaxis Following Cesarean Delivery in Obese WomenAn Exception to the Rule? JAMA. 2017;318(11):1012-1013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975285 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2654362 - ↑ 15.0 15.1 Anello J, Feinberg B, Lindsey R et al Vaginal Birth After Cesarean Clinical Practice Guidelines, December 2017 Medscape. Dec 6, 2017 https://reference.medscape.com/viewarticle/889632_14
Brown T. Updated Guidelines on VBAC Released by ACOG. Medscape News. WebMD Inc. November 7, 2017. https://www.medscape.com/viewarticle/888126
Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2017 Nov;130(5):e217-e233. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29064970 https://insights.ovid.com/pubmed?pmid=29064970