Prevent Complications Associated With Cesarean Delivery

A wonderful, concise, evidence-based article by Dr. Patrick Duff was published in the December edition of Obstetrics and Gynecology entitled, "A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery".

Dr. Duff proposed the following evidence-based eight steps to significantly reduce maternal morbidity and mortality associated with cesarean delivery:

1. Clip the hair at the surgical site just before making the incision

2. Cleanse the skin with chlorhexidine solution rather than povidone-iodine solution

3. Administer broad-spectrum systemic antibiotic prophylaxis before the surgical incision rather than after the neonate's umbilical cord is clamped

4. Remove the placenta by traction on the umbilical cord rather than by manual extraction

5. Close the uterine incision in two layers rather than one

6. In women whose subcutaneous tissue is greater than 2 cm in thickness, close the layer with a running suture

7. Patients at intermediate risk for deep vein thrombosis [BMI > 30, those with gross varicose veins, those immobilized for > 4 days before surgery, those who have concurrent medical illness that predisposes to thromboembolism (e.g. sickle cell disease, sickle cell C disease, cancer, antiphospholipid syndrome, hereditary thrombophilia with no history of DVT or PE)] should receive prophylaxis postoperatively with either sequential compression devices or subcutaneous heparin

8. Patients at high risk for postoperative deep vein thrombosis (those with more than two risk factors in the moderate-risk category, those with prior DVT or PE, those who have a cesarean hysterectomy) should receive prophylaxis with both sequential compression devices and subcutaneous heparin until the patient is fully ambulatory

Referenced article: Obstet Gynecol 2010;116:1393-6