Cesarean section - Revision history

Asdoyal: Tests possibly needed.

2024-10-12T13:21:54Z

Tests possibly needed.

← Older revision		Revision as of 06:21, 12 October 2024
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	*Chemistry panel		*Chemistry panel
	*Complete Blood Count (CBC)		*Complete Blood Count (CBC)
	* Other tests as indicated by H&P		* Other tests as indicated by H&P, e.g. Rotem, Platelet Function, Fibrinogen level

	===Operating room setup===		===Operating room setup===

Blainesa: added information about regional versus general anesthesia in C section and various techniques

2022-09-29T18:08:37Z

added information about regional versus general anesthesia in C section and various techniques

← Older revision		Revision as of 11:08, 29 September 2022
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	\|Neurologic		\|Neurologic
	\|		\|
			* Seizures or cerebrovascular accident in patients who progress to eclampsia
	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
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	===Patient preparation and premedication===		===Patient preparation and premedication===

	* Full stomach precautions		* Full stomach precautions typically employed if the mother has been laboring prior to cesarean section. There is some controversy regarding whether non-laboring parturients (eg, elective C-section) should be considered "full stomachs".
	*Nonparticulate oral antacid (e.g. sodium citrate) immediately prior to general or regional anesthesia		*Nonparticulate oral antacid (e.g. sodium citrate) immediately prior to general or regional anesthesia.
	*Intravenous promotility agent (eg. metoclopramide)		*Intravenous promotility agent (eg. 10 mg metoclopramide given over 5-10 minutes). Patients may experience akathisia if given too rapidly.
	*Intravenous antacids (e.g. ranitidine, famotidine)		*Intravenous antacids (e.g. ranitidine, famotidine). Onset of action 30 minutes.
	* Anxiolysis not typically used unless patient is extremely anxious		* Anxiolysis (benzodiazepines or opiates) not typically used unless patient is extremely anxious due to concern for fetal respiratory depression from placental transfer
	*Elevate the right hip to provide left uterine displacement		*Elevate the right hip to provide left uterine displacement
	*Adjunctive azithromycin 500mg IV to standard beta-lactam antibiotics shown to reduce the incidence in endometriosis and wound infection occurring in the first 6 weeks after Cesarean Section<ref>{{Cite journal\|last=Tita\|first=Alan T.N.\|last2=Szychowski\|first2=Jeff M.\|last3=Boggess\|first3=Kim\|last4=Saade\|first4=George\|last5=Longo\|first5=Sherri\|last6=Clark\|first6=Erin\|last7=Esplin\|first7=Sean\|last8=Cleary\|first8=Kirsten\|last9=Wapner\|first9=Ron\|last10=Letson\|first10=Kellett\|last11=Owens\|first11=Michelle\|date=2016-09-29\|title=Adjunctive Azithromycin Prophylaxis for Cesarean Delivery\|url=http://www.nejm.org/doi/10.1056/NEJMoa1602044\|journal=New England Journal of Medicine\|language=en\|volume=375\|issue=13\|pages=1231–1241\|doi=10.1056/NEJMoa1602044\|issn=0028-4793\|pmc=PMC5131636\|pmid=27682034}}</ref>.		*Adjunctive azithromycin 500mg IV to standard beta-lactam antibiotics shown to reduce the incidence in endometriosis and wound infection occurring in the first 6 weeks after Cesarean Section<ref>{{Cite journal\|last=Tita\|first=Alan T.N.\|last2=Szychowski\|first2=Jeff M.\|last3=Boggess\|first3=Kim\|last4=Saade\|first4=George\|last5=Longo\|first5=Sherri\|last6=Clark\|first6=Erin\|last7=Esplin\|first7=Sean\|last8=Cleary\|first8=Kirsten\|last9=Wapner\|first9=Ron\|last10=Letson\|first10=Kellett\|last11=Owens\|first11=Michelle\|date=2016-09-29\|title=Adjunctive Azithromycin Prophylaxis for Cesarean Delivery\|url=http://www.nejm.org/doi/10.1056/NEJMoa1602044\|journal=New England Journal of Medicine\|language=en\|volume=375\|issue=13\|pages=1231–1241\|doi=10.1056/NEJMoa1602044\|issn=0028-4793\|pmc=PMC5131636\|pmid=27682034}}</ref>.
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	===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===		===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===

			*Neuraxial anesthesia is preferred unless there are strict contraindications (eg, patient refusal, inadequate anesthesia with existing epidural in an emergency situation, thrombocytopenia in the setting of pre-eclampsia or HELLP). General anesthesia with volatile anesthetics exposes the mother to the risk of difficult airway secondary to upper airway edema and increased bleeding due to uterine relaxation.
			**Elective C-section
			***Spinal anesthesia employed with 10-12.5 mg of hyperbaric bupivacaine (0.75% in dextrose), 15 mcg of fentanyl, and 100-200 mcg of morphine.
			***If risk factors for prolonged duration of surgery are present such as obesity, prior C-section, or prior abdominal surgery, 5 mcg of epinephrine can be added to the spinal anesthetic dose to prolong duration of blockade.
			**Urgent C-section in laboring parturient
			***Existing labor epidural should be utilized and dosed with 2% lidocaine for rapid achievement of surgical anesthesia to the level of T4.
			****2 mL of bicarbonate and 5 mcg of epinephrine can be added to the lidocaine to speed the onset of action.
			****0.5% bupivacaine can also be utilized if there is adequate time for its onset of action (10-15 minutes).
			****100 mcg of epidural fentanyl can be administered to increase the density of the block.
			***Spinal anesthesia should be attempted if there is sufficient time (stability of fetal heart rate tracing)
			**Emergency C-section
			***20 mL of 3% chloroprocaine should be administered through an existing epidural catheter to achieve rapid surgical anesthesia (roughly 8 minutes to peak effect)
			***General anesthesia should be employed if surgical anesthesia cannot be obtained with an existing epidural or if there is no epidural in place.
			****RSI with propofol and succinylcholine (etomidate if concern for cardiovascular instability).
			****Smaller ETT size generally used (6.0-6.5) due to concern for maternal airway edema in the setting of labor.
			****Sevoflurane used for maintenance of anesthesia initially and 70% nitrous oxide in 30% oxygen after delivery of the fetus to reduce the amount of sevoflurane (which has a higher tendency to produce tocolysis and increase bleeding). Opiates (eg, hydromorphone) can be administered after delivery of the fetus.
	*Avoid nasal airways due to potential for mucosal capillary engorgement in upper airway		*Avoid nasal airways due to potential for mucosal capillary engorgement in upper airway

TLucas at 21:02, 30 August 2022

2022-08-30T21:02:18Z

← Older revision		Revision as of 14:02, 30 August 2022
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	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}
	A '''cesarean section''' (also known as '''C-section''') is a surgical procedure where the baby is delivered through an incision in the uterus. C-sections are typically performed when a vaginal delivery would put the mother or baby at risk. In the USA, about 32% of deliveries are via Cesarean section<ref>{{Cite web\|date=2021-03-24\|title=FastStats\|url=https://www.cdc.gov/nchs/fastats/delivery.htm\|access-date=2021-05-27\|website=www.cdc.gov\|language=en-us}}</ref>, and worldwide the figure is approximately 21%.<ref>{{Cite journal\|last=Boerma\|first=Ties\|last2=Ronsmans\|first2=Carine\|last3=Melesse\|first3=Dessalegn Y.\|last4=Barros\|first4=Aluisio J. D.\|last5=Barros\|first5=Fernando C.\|last6=Juan\|first6=Liang\|last7=Moller\|first7=Ann-Beth\|last8=Say\|first8=Lale\|last9=Hosseinpoor\|first9=Ahmad Reza\|last10=Yi\|first10=Mu\|last11=Neto\|first11=Dácio de Lyra Rabello\|date=2018-10-13\|title=Global epidemiology of use of and disparities in caesarean sections\|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31928-7/abstract\|journal=The Lancet\|language=English\|volume=392\|issue=10155\|pages=1341–1348\|doi=10.1016/S0140-6736(18)31928-7\|issn=0140-6736\|pmid=30322584}}</ref>		A '''cesarean section''' (also known as '''C-section''' or '''cesarean delivery''' ) is a surgical procedure where the baby is delivered through an incision in the uterus. C-sections are typically performed when a vaginal delivery would put the mother or baby at risk. Often women who have had a cesarean delivery will have a subsequent or ''repeat'' cesarean delivery to prevent the possibility of uterine rupture during labor. In the USA, about 32% of deliveries are via Cesarean section<ref>{{Cite web\|date=2021-03-24\|title=FastStats\|url=https://www.cdc.gov/nchs/fastats/delivery.htm\|access-date=2021-05-27\|website=www.cdc.gov\|language=en-us}}</ref>, and worldwide the figure is approximately 21%.<ref>{{Cite journal\|last=Boerma\|first=Ties\|last2=Ronsmans\|first2=Carine\|last3=Melesse\|first3=Dessalegn Y.\|last4=Barros\|first4=Aluisio J. D.\|last5=Barros\|first5=Fernando C.\|last6=Juan\|first6=Liang\|last7=Moller\|first7=Ann-Beth\|last8=Say\|first8=Lale\|last9=Hosseinpoor\|first9=Ahmad Reza\|last10=Yi\|first10=Mu\|last11=Neto\|first11=Dácio de Lyra Rabello\|date=2018-10-13\|title=Global epidemiology of use of and disparities in caesarean sections\|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31928-7/abstract\|journal=The Lancet\|language=English\|volume=392\|issue=10155\|pages=1341–1348\|doi=10.1016/S0140-6736(18)31928-7\|issn=0140-6736\|pmid=30322584}}</ref>

	== Preoperative management ==		== Preoperative management ==
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	\|		\|
	* Pregnant patients typically have compensated respiratory alkalosis, increased minute ventilation, decreased FRC, and increased oxygen consumption.		* Pregnant patients typically have compensated respiratory alkalosis, increased minute ventilation, decreased FRC, and increased oxygen consumption.
	* Decreased FRC results in rapid desaturation if ventilation is compromised.		* Decreased FRC and increased O<sub>2</sub> consumption results in rapid desaturation if ventilation is compromised.
	* Atelectasis can occur secondary to an elevated diaphragm, thereby causing V/Q mismatch and decreased PaO<sub>2.</sub>		* Atelectasis can occur secondary to an elevated diaphragm, thereby causing V/Q mismatch and decreased PaO<sub>2.</sub>
	* Increased MV and decreased FRC increase uptake of ~~inhalational~~ agents.		* Increased MV and decreased FRC increase uptake of inhalation agents.
	* Mucosal capillary engorgement in upper airway may necessitate smaller endotracheal tube.		* Mucosal capillary engorgement in upper airway may necessitate smaller endotracheal tube.
	\|-		\|-
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	*Decreased BP common with spinal anesthesia		*Decreased BP common with spinal anesthesia
	*Given fluid pre-load or co-load		*Given fluid pre-load or co-load
	*Be prepared to provide bolus as vasopressors as needed		*Be prepared to provide bolus of
			*vasopressors as needed
	\|		\|
	*GA normally used when neuraxial contraindicated or when there is not enough time to perform a block due to obstetric emergency		*GA normally used when neuraxial contraindicated or when there is not enough time to perform a block due to obstetric emergency

Aharari: added to hematologic effects during pregnancy

2022-07-20T10:43:13Z

added to hematologic effects during pregnancy

Show changes

Tony.Wang: add misoprostol

2022-07-14T20:19:39Z

add misoprostol

← Older revision		Revision as of 13:19, 14 July 2022
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	* Start [[oxytocin]] 30U in 500mL fluid over 3 hours after clamping of umbilical cord		* Start [[oxytocin]] 30U in 500mL fluid over 3 hours after clamping of umbilical cord
	* Monitor for hemodynamic variance (e.g. hypotension) after starting oxytocin		* Monitor for hemodynamic variance (e.g. hypotension) after starting oxytocin
	* Additional uterotonics may be requested by surgeon if uterine tone is not adequate (e.g. [[methylergonovine]], [[carboprost]])		* Additional uterotonics may be requested by surgeon if uterine tone is not adequate (e.g. [[methylergonovine]], [[carboprost]], misoprostol)

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

Chris.Rishel at 07:33, 5 April 2022

2022-04-05T07:33:45Z

← Older revision		Revision as of 00:33, 5 April 2022
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	\| anesthesia_type = Neuraxial or general		\| anesthesia_type = Neuraxial or general
	\| airway = ETT if general		\| airway = ETT if general
	\| lines_access = ~~2 large~~ bore ~~PIV~~		\| lines_access = Large bore IV x2
	\| monitors = Standard ~~ASA <br>~~		\| monitors = Standard
	Fetal heart rate monitor		Fetal heart rate monitor
	\| considerations_preoperative = Full stomach precautions ~~<br>~~		\| considerations_preoperative = Full stomach precautions
	Aspiration prophylaxis ~~<br>~~		Aspiration prophylaxis
	Left lateral tilt		Left lateral tilt
	\| considerations_intraoperative = ~~Blood loss: 700-1000mL~~		\| considerations_intraoperative = Have uterotonics available
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}
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	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
	Standard ~~ASA~~ monitors
			* Standard monitors

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
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	* Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output		* Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output
	* Tranexamic acid 1g administered over 30-60 seconds during the first 3 minutes after birth, and after the uterotonic agent has been administered (e.g. oxytocin) is shown to reduce the incidence of post-operative blood loss > 1000 mL by POD #2 or RBC transfusion<ref>{{Cite journal\|last=Sentilhes\|first=Loïc\|last2=Sénat\|first2=Marie V.\|last3=Le Lous\|first3=Maëla\|last4=Winer\|first4=Norbert\|last5=Rozenberg\|first5=Patrick\|last6=Kayem\|first6=Gilles\|last7=Verspyck\|first7=Eric\|last8=Fuchs\|first8=Florent\|last9=Azria\|first9=Elie\|last10=Gallot\|first10=Denis\|last11=Korb\|first11=Diane\|date=2021-04-29\|title=Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery\|url=http://www.nejm.org/doi/10.1056/NEJMoa2028788\|journal=New England Journal of Medicine\|language=en\|volume=384\|issue=17\|pages=1623–1634\|doi=10.1056/NEJMoa2028788\|issn=0028-4793}}</ref>.		* Tranexamic acid 1g administered over 30-60 seconds during the first 3 minutes after birth, and after the uterotonic agent has been administered (e.g. oxytocin) is shown to reduce the incidence of post-operative blood loss > 1000 mL by POD #2 or RBC transfusion<ref>{{Cite journal\|last=Sentilhes\|first=Loïc\|last2=Sénat\|first2=Marie V.\|last3=Le Lous\|first3=Maëla\|last4=Winer\|first4=Norbert\|last5=Rozenberg\|first5=Patrick\|last6=Kayem\|first6=Gilles\|last7=Verspyck\|first7=Eric\|last8=Fuchs\|first8=Florent\|last9=Azria\|first9=Elie\|last10=Gallot\|first10=Denis\|last11=Korb\|first11=Diane\|date=2021-04-29\|title=Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery\|url=http://www.nejm.org/doi/10.1056/NEJMoa2028788\|journal=New England Journal of Medicine\|language=en\|volume=384\|issue=17\|pages=1623–1634\|doi=10.1056/NEJMoa2028788\|issn=0028-4793}}</ref>.
	* Start oxytocin 30U in 500mL fluid over 3 hours after clamping of umbilical cord		* Start [[oxytocin]] 30U in 500mL fluid over 3 hours after clamping of umbilical cord
	* Monitor for hemodynamic variance (e.g. hypotension) after starting oxytocin		* Monitor for hemodynamic variance (e.g. hypotension) after starting oxytocin
	* Additional uterotonics may be requested by surgeon if uterine tone is not adequate (e.g. ~~metheylergonivine~~, carboprost)		* Additional uterotonics may be requested by surgeon if uterine tone is not adequate (e.g. [[methylergonovine]], [[carboprost]])

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===

	* Epidural ~~Morphine~~ 1-3mg for long acting post-partum pain relief<ref>{{Cite journal\|last=Fuller\|first=John G.\|last2=McMorland\|first2=Graham H.\|last3=Douglas\|first3=M. Joanne\|last4=Palmer\|first4=Lynne\|date=1990-09\|title=Epidural morphine for analgesia after Caesarean section: a report of 4880 patients\|url=http://link.springer.com/10.1007/BF03006481\|journal=Canadian Journal of Anaesthesia\|language=en\|volume=37\|issue=6\|pages=636–640\|doi=10.1007/BF03006481\|issn=0832-610X}}</ref><ref>{{Cite journal\|last=Bollag\|first=Laurent\|last2=Lim\|first2=Grace\|last3=Sultan\|first3=Pervez\|last4=Habib\|first4=Ashraf S.\|last5=Landau\|first5=Ruth\|last6=Zakowski\|first6=Mark\|last7=Tiouririne\|first7=Mohamed\|last8=Bhambhani\|first8=Sumita\|last9=Carvalho\|first9=Brendan\|date=2021-05\|title=Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean\|url=https://journals.lww.com/10.1213/ANE.0000000000005257\|journal=Anesthesia & Analgesia\|language=en\|volume=132\|issue=5\|pages=1362–1377\|doi=10.1213/ANE.0000000000005257\|issn=0003-2999}}</ref>		* Epidural [[morphine]] 1-3mg for long acting post-partum pain relief<ref>{{Cite journal\|last=Fuller\|first=John G.\|last2=McMorland\|first2=Graham H.\|last3=Douglas\|first3=M. Joanne\|last4=Palmer\|first4=Lynne\|date=1990-09\|title=Epidural morphine for analgesia after Caesarean section: a report of 4880 patients\|url=http://link.springer.com/10.1007/BF03006481\|journal=Canadian Journal of Anaesthesia\|language=en\|volume=37\|issue=6\|pages=636–640\|doi=10.1007/BF03006481\|issn=0832-610X}}</ref><ref>{{Cite journal\|last=Bollag\|first=Laurent\|last2=Lim\|first2=Grace\|last3=Sultan\|first3=Pervez\|last4=Habib\|first4=Ashraf S.\|last5=Landau\|first5=Ruth\|last6=Zakowski\|first6=Mark\|last7=Tiouririne\|first7=Mohamed\|last8=Bhambhani\|first8=Sumita\|last9=Carvalho\|first9=Brendan\|date=2021-05\|title=Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean\|url=https://journals.lww.com/10.1213/ANE.0000000000005257\|journal=Anesthesia & Analgesia\|language=en\|volume=132\|issue=5\|pages=1362–1377\|doi=10.1213/ANE.0000000000005257\|issn=0003-2999}}</ref>
	* IT ~~Morphine~~ 50-150mcg for long acting post-partum pain relief if spinal performed<ref>{{Cite journal\|last=Bollag\|first=Laurent\|last2=Lim\|first2=Grace\|last3=Sultan\|first3=Pervez\|last4=Habib\|first4=Ashraf S.\|last5=Landau\|first5=Ruth\|last6=Zakowski\|first6=Mark\|last7=Tiouririne\|first7=Mohamed\|last8=Bhambhani\|first8=Sumita\|last9=Carvalho\|first9=Brendan\|date=2021-05\|title=Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean\|url=https://journals.lww.com/10.1213/ANE.0000000000005257\|journal=Anesthesia & Analgesia\|language=en\|volume=132\|issue=5\|pages=1362–1377\|doi=10.1213/ANE.0000000000005257\|issn=0003-2999}}</ref>		* IT morphine 50-150mcg for long acting post-partum pain relief if spinal performed<ref>{{Cite journal\|last=Bollag\|first=Laurent\|last2=Lim\|first2=Grace\|last3=Sultan\|first3=Pervez\|last4=Habib\|first4=Ashraf S.\|last5=Landau\|first5=Ruth\|last6=Zakowski\|first6=Mark\|last7=Tiouririne\|first7=Mohamed\|last8=Bhambhani\|first8=Sumita\|last9=Carvalho\|first9=Brendan\|date=2021-05\|title=Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean\|url=https://journals.lww.com/10.1213/ANE.0000000000005257\|journal=Anesthesia & Analgesia\|language=en\|volume=132\|issue=5\|pages=1362–1377\|doi=10.1213/ANE.0000000000005257\|issn=0003-2999}}</ref>
	* IV acetaminophen		* IV [[acetaminophen]]
	* Ibuprofen PO post-op		* [[Ibuprofen]] PO post-op
	* ± ~~ketoralac~~ (dependent upon surgeon preference and total blood loss)		* ± [[Ketorolac]] (dependent upon surgeon preference and total blood loss)
	* ± Wound infiltration		* ± Wound infiltration
	* ± Transversus abdominal block (TAP block) or quadratus lumborum block (for patients undergoing general anesthesia or neuroaxial without intrathecal opioid administration)		* ± Transversus abdominal block (TAP block) or quadratus lumborum block (for patients undergoing general anesthesia or neuroaxial without intrathecal opioid administration)

Eeshwar.Chandrasekar at 01:34, 15 March 2022

2022-03-15T01:34:16Z

← Older revision		Revision as of 18:34, 14 March 2022
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	* Iron deficiency anemia + dilutional anemia of pregnancy		* Iron deficiency anemia + dilutional anemia of pregnancy
	* Excessive blood loss possible with uterine atony, multiple gestation, previous C-section, placental pregnancy, placental abruption, pregnancy induced hypertension, or prolonged labor.		* Excessive blood loss possible with uterine atony, multiple gestation, previous C-section, placental pregnancy, placental abruption, pregnancy induced hypertension, or prolonged labor.

	*
	\|-		\|-
	\|Renal		\|Renal
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	* Tranexamic acid 1g administered over 30-60 seconds during the first 3 minutes after birth, and after the uterotonic agent has been administered (e.g. oxytocin) is shown to reduce the incidence of post-operative blood loss > 1000 mL by POD #2 or RBC transfusion<ref>{{Cite journal\|last=Sentilhes\|first=Loïc\|last2=Sénat\|first2=Marie V.\|last3=Le Lous\|first3=Maëla\|last4=Winer\|first4=Norbert\|last5=Rozenberg\|first5=Patrick\|last6=Kayem\|first6=Gilles\|last7=Verspyck\|first7=Eric\|last8=Fuchs\|first8=Florent\|last9=Azria\|first9=Elie\|last10=Gallot\|first10=Denis\|last11=Korb\|first11=Diane\|date=2021-04-29\|title=Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery\|url=http://www.nejm.org/doi/10.1056/NEJMoa2028788\|journal=New England Journal of Medicine\|language=en\|volume=384\|issue=17\|pages=1623–1634\|doi=10.1056/NEJMoa2028788\|issn=0028-4793}}</ref>.		* Tranexamic acid 1g administered over 30-60 seconds during the first 3 minutes after birth, and after the uterotonic agent has been administered (e.g. oxytocin) is shown to reduce the incidence of post-operative blood loss > 1000 mL by POD #2 or RBC transfusion<ref>{{Cite journal\|last=Sentilhes\|first=Loïc\|last2=Sénat\|first2=Marie V.\|last3=Le Lous\|first3=Maëla\|last4=Winer\|first4=Norbert\|last5=Rozenberg\|first5=Patrick\|last6=Kayem\|first6=Gilles\|last7=Verspyck\|first7=Eric\|last8=Fuchs\|first8=Florent\|last9=Azria\|first9=Elie\|last10=Gallot\|first10=Denis\|last11=Korb\|first11=Diane\|date=2021-04-29\|title=Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery\|url=http://www.nejm.org/doi/10.1056/NEJMoa2028788\|journal=New England Journal of Medicine\|language=en\|volume=384\|issue=17\|pages=1623–1634\|doi=10.1056/NEJMoa2028788\|issn=0028-4793}}</ref>.
	* Start oxytocin 30U in 500mL fluid over 3 hours after clamping of umbilical cord		* Start oxytocin 30U in 500mL fluid over 3 hours after clamping of umbilical cord
	* Monitor for hemodynamic variance after starting oxytocin		* Monitor for hemodynamic variance (e.g. hypotension) after starting oxytocin
	* Additional uterotonics may be requested by surgeon if uterine tone is not adequate		* Additional uterotonics may be requested by surgeon if uterine tone is not adequate (e.g. metheylergonivine, carboprost)

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

Chris.Rishel at 01:23, 12 March 2022

2022-03-12T01:23:48Z

← Older revision		Revision as of 18:23, 11 March 2022
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	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}
	A '''cesarean section''' (also known as '''C-section''') is a surgical procedure where the baby is delivered through an incision in the uterus. C-sections are typically performed when a vaginal delivery would put the mother or baby at risk. In the USA, about 32% of deliveries are via Cesarean section<ref>{{Cite web\|date=2021-03-24\|title=FastStats\|url=https://www.cdc.gov/nchs/fastats/delivery.htm\|access-date=2021-05-27\|website=www.cdc.gov\|language=en-us}}</ref>, and worldwide the figure is approximately 21%<ref>{{Cite journal\|last=Boerma\|first=Ties\|last2=Ronsmans\|first2=Carine\|last3=Melesse\|first3=Dessalegn Y.\|last4=Barros\|first4=Aluisio J. D.\|last5=Barros\|first5=Fernando C.\|last6=Juan\|first6=Liang\|last7=Moller\|first7=Ann-Beth\|last8=Say\|first8=Lale\|last9=Hosseinpoor\|first9=Ahmad Reza\|last10=Yi\|first10=Mu\|last11=Neto\|first11=Dácio de Lyra Rabello\|date=2018-10-13\|title=Global epidemiology of use of and disparities in caesarean sections\|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31928-7/abstract\|journal=The Lancet\|language=English\|volume=392\|issue=10155\|pages=1341–1348\|doi=10.1016/S0140-6736(18)31928-7\|issn=0140-6736\|pmid=30322584}}</ref>.		A '''cesarean section''' (also known as '''C-section''') is a surgical procedure where the baby is delivered through an incision in the uterus. C-sections are typically performed when a vaginal delivery would put the mother or baby at risk. In the USA, about 32% of deliveries are via Cesarean section<ref>{{Cite web\|date=2021-03-24\|title=FastStats\|url=https://www.cdc.gov/nchs/fastats/delivery.htm\|access-date=2021-05-27\|website=www.cdc.gov\|language=en-us}}</ref>, and worldwide the figure is approximately 21%.<ref>{{Cite journal\|last=Boerma\|first=Ties\|last2=Ronsmans\|first2=Carine\|last3=Melesse\|first3=Dessalegn Y.\|last4=Barros\|first4=Aluisio J. D.\|last5=Barros\|first5=Fernando C.\|last6=Juan\|first6=Liang\|last7=Moller\|first7=Ann-Beth\|last8=Say\|first8=Lale\|last9=Hosseinpoor\|first9=Ahmad Reza\|last10=Yi\|first10=Mu\|last11=Neto\|first11=Dácio de Lyra Rabello\|date=2018-10-13\|title=Global epidemiology of use of and disparities in caesarean sections\|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31928-7/abstract\|journal=The Lancet\|language=English\|volume=392\|issue=10155\|pages=1341–1348\|doi=10.1016/S0140-6736(18)31928-7\|issn=0140-6736\|pmid=30322584}}</ref>

	== Preoperative management ==		== Preoperative management ==

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:46:02Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:46, 21 February 2022
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	* Evaluate for pregnancy induced hypertension (PIH)		* Evaluate for pregnancy induced hypertension (PIH)
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|		\|
	* Pregnant patients typically have compensated respiratory alkalosis, increased minute ventilation, decreased FRC, and increased oxygen consumption.		* Pregnant patients typically have compensated respiratory alkalosis, increased minute ventilation, decreased FRC, and increased oxygen consumption.

Chris.Rishel at 13:47, 5 November 2021

2021-11-05T13:47:12Z

← Older revision		Revision as of 06:47, 5 November 2021
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	* Be prepared to provide bolus as vasopressors as needed		* Be prepared to provide bolus as vasopressors as needed
	\|		\|
	* GA normally used ~~with regional technique~~ contraindicated or when there is not enough time to perform a block due to obstetric emergency		* GA normally used when neuraxial contraindicated or when there is not enough time to perform a block due to obstetric emergency

	* Rapid sequence induction (RSI)		* Rapid sequence induction (RSI)