|Anesthesia type||General vs. Regional|
|Airway||ETT if GA|
|Lines and access||2 large bore PIV|
|Primary anesthetic considerations|
|Preoperative||Full stomach precautions
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. As of 2017, about 32% of deliveries in the United States were performed via C-section.
|Gastrointestinal / Hepatic||
Labs and studies
- T&C only if significant blood loss anticipated
- Coagulation panel
- Chemistry panel
- Complete Blood Count (CBC)
- Other tests as indicated by H&P
Operating room setup
Patient preparation and premedication
- Full stomach precautions
- Nonparticulate oral antacid (e.g. sodium citrate) immediately prior to general or regional anesthesia
- Intravenous promotility agent (eg. metoclopramide)
- Intravenous antacids (e.g. ranitidine, famotidine)
- Anxiolysis not typically used unless patient is extremely anxious
- 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.
Regional and neuraxial techniques
- Epidural, spinal, and combined spinal-epidural (CSE) techniques are all commonly employed
- Check coagulation and platelets panel prior to neuraxial anesthesia
Monitoring and access
Induction and airway management
- Avoid nasal airways due to potential for mucosal capillary engorgement in upper airway
- Left lateral tilt (15o) to avoid aortocaval compression and supine hypotension.
Maintenance and surgical considerations
- Anticipate EBL of 700-1000 mL
- Be prepared for excessive blood loss if underlying risk factors
- 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.
- "Births: Provisional Data for 2017" (PDF). CDC. May 2018. Retrieved 18 May 2018.
- Tita, Alan T.N.; Szychowski, Jeff M.; Boggess, Kim; Saade, George; Longo, Sherri; Clark, Erin; Esplin, Sean; Cleary, Kirsten; Wapner, Ron; Letson, Kellett; Owens, Michelle (2016-09-29). "Adjunctive Azithromycin Prophylaxis for Cesarean Delivery". New England Journal of Medicine. 375 (13): 1231–1241. doi:10.1056/NEJMoa1602044. ISSN 0028-4793. PMC 5131636. PMID 27682034.CS1 maint: PMC format (link)
- Sentilhes, Loïc; Sénat, Marie V.; Le Lous, Maëla; Winer, Norbert; Rozenberg, Patrick; Kayem, Gilles; Verspyck, Eric; Fuchs, Florent; Azria, Elie; Gallot, Denis; Korb, Diane (2021-04-29). "Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery". New England Journal of Medicine. 384 (17): 1623–1634. doi:10.1056/NEJMoa2028788. ISSN 0028-4793.