Caesarean Section

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CLINICAL DESCRIPTION

Delivery of the baby through an abdominal incision for maternal or fetal indication. 

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • The following clinical features may suggest an indication for referral for caesarean section: Cephalopelvic disproportion, breech presentation or any other malpresentation, fetal macrosomia, malposition, previous c-section delivery, history of myomectomy, fetal distress, failed induction of labour.

Management

Management at the health Centre

  • Refer to the Hospital
  • Pre – referral management
    • Insert a large intravenous cannula (preferably green or grey)
    • Collect blood samples for FBC and group and cross match
    • Commence IV Fluids (Normal saline or Ringer’s Lactate, but never 5% dextrose)
    • Catheterize the patient
    • Explain the findings to the patient

At District Hospital

  • Preoperative management
    • Prophylaxis:
      • Give Cefazolin 2g IV STAT OR Ampicillin 1g IV STAT  (30 min - 1hr before operation)
      • OR Ceftriaxone 2g IV STAT if the other two drugs are unavailable
    • Ensure FBC result to assess hemoglobin level and platelet count.  
    • Get consent

Post-operative management

  • Analgesia
    • Opiates
      • Pethidine 50 – 100 mg IM 4 hourly for 48 hours OR
      • Morphine 5 – 10 mg IM 4 hourly for 48 hours
    • NSAIDS
      • Diclofenac suppository 100mg 12 hourly for 5 days OR
      • Ibuprofen 400mg PO 8 hourly for 5 – 7 days
      • Paracetamol 1g PO 6 hourly for 5 – 7 days
  • Antibiotics
    • Indications; offensive smelling liquor (Chorioamnionitis), prolonged surgery (> 2 hours), massive blood loss (>1500mls), surgical site contamination, prolonged labour with multiple vaginal examinations (≥ 6 VEs).
    • 1st Line: Ampicillin 1g IV 8 hourly and Metronidazole 500mg IV 8 hourly for 5 days (or metronidazole 400mg PO 8 hourly for 5 days)
    • Second line: Ceftriaxone 2g IV daily for 5 days and Metronidazole 500mg 8 hourly for 5 days (or Metronidazole 400mg PO 8 hourly for 5 days)
  • Monitor for signs of sepsis throughout the postoperative stay. Provide routine post-operative wound care