Care of Cesarean Section 

TITLE:

Care of Cesarean Section 

2. PURPOSE:

To describe the management and preparation of Elective and Emergency Cesarean Section.

3. CONDITION/ APPLICABILITY:

This procedure shall apply to all licensed Nurses/ Midwives and Medical Staff in Labor and Delivery (L&D), Neonatal Intensive Care Unit (NICU), Operating Room and OB ward.

4. DEFINITION:

Cesarean section: is an obstetrical procedure to remove the fetus through an incision in the abdominal wall and uterus.

5. POLICY:

1. The Consultant will decide if the patient will be admitted for elective Cesarean Section. If so, arrangements for admission and OR booking should be done.

2. Every effort will be made to quickly perform the pre-operative requirements and transport the patient to OR/ CS ROOM

6. PROCEDURE:

1. Elective Cesarean Section

1. On the previous evening of admission date, the role of doctors and nurse/midwife in OB ward should be:

   1. Welcome the patient and orient her to the room environment.

   2. Ensure that the patient understands the procedure involved leading up to Cesarean Section. 

   3. Complete admission procedures.

   4. Complete OR documentation and prepare the baby’s file.

   5. Perform abdominal palpation and baseline CTG.

   6. Get the patient’s baseline vital signs.

   7. Perform urinalysis as ordered.

   8. Inform Resident on duty of admission. Ensure that OR notification through booking in Trak Care has been done and consent form was signed.

   9. In case the patient is younger than 18 years old the husband must sign the medical and surgical consents.

   10. Ensure all blood tests are up-to-date and repeated as necessary. 

   11. Extract blood and save a sample for grouping and cross matching if necessary.

   12. Ensure that the pregnancy is open or created by Resident or Specialist on duty in.

   13. Ensure that routine blood investigations such as ABG for cord blood sample are ordered by Residents/Specialist on duty.

   14. Ensure that the patient was seen by the anesthetist.

   15. Ensure that patient takes a shower before the operation 

   16. Administer antacid “10 ml of anti-acid one hour before anesthesia” and histamine 

   17. Do not administer preoperative sedation  

   18. Do not administer oral or mechanical bowel prep   

   19. Preoperative fasting: encourage clear fluids (pulp free juice, coffee, tea without milk) up to 2 hours before surgery and preoperative carbohydrate supplementation for non-diabetic patient.  

   20. Light meal up until 8 hours before surgery

   21. Place Null Per Oral sign above the patient’s bed 2 hrs before the surgery.

   22. On the morning of surgery, the roles of the nurses/midwives are:

       1. To administer pre-medications as ordered by the anesthetist / Obstetrician.

       2. The commence Intravenous infusion as ordered by the Obstetrician.

       3. Take vital signs (temperature, pulse, blood pressure) and auscultation of fetal heart rate.

       4. Remove any jewelry, prosthesis, dentures or hair clips.

       5. Complete the OR checklist.

       6. Ensure that the pediatrician is notified before transferring the patient to the Operating Room. Pediatrician must be present during timeout.

       7. Once documentation is completed, accompany the patient to OR and ensure patient privacy. The nursery staff will remain in the theater to receive the baby.

       8. The L and D staff are responsible to scrub in the surgery. The Nursery staffs are responsible to receive the baby.

       9. In case any emergency intra operatively and hysterectomy needed, the attending  Physician can take decision for hysterectomy without consent of the patient. But the consent must be signed by two Consultants and the assisting Specialist or Resident.

       10. In case the couple want a tubal ligation,the consultant must discuss this antenatally. The consent must be signed by both: the husband and the wife in adittion to 2 physicians (one of them has to be a consultant). 

       11. In cases the patient had one or more previous c-sections,  the senior registrar or senior resident can perform the operation with  the consultant attending in the operation room. In case any complication arises the consultant in-charge will take over.

2. Emergency Cesarean Section

1. The consultant in charge of the case can delegate the c-section to a Senior Registrar/ Registrar or Senior Resident to start. Provided that all information is given to the consultant in-charge. However, in case any complications arise, the consultant in-charge will take over.

2. The OB/GYNE specialist or resident shall inform the Anesthesiologist and Pediatrician about the need for surgery.

3. The Nurse/Midwife of L&D will inform the NICU/Nursery nursing staff regarding CS.

4. The L and D staff are responsible to scrub in surgery. The Nursery staff are responsible to receive the baby.

5. Preparation of the patient

   1. Check patient identification.

   2. Ensure that the consent form is signed.

   3. Perform aseptic hair clipping.

   4. Place a clean gown and a cap on the patient.

   5. Remove jewelries and prosthesis.

   6. Tape any jewelry that can’t be removed and ensure that it does not touch the skin.

   7. Start intravenous infusion as ordered.

   8. Insert Foley catheter as ordered.

   9. Insure leg pneumatic device and elastic stoking intra and post operatively

   10. Administer antacids as ordered.

   11.  Administer antibiotics as order

   12. Place complete chart/ file, coded ID band, Hugs and Kisses devices and birth notification to CS theater. 

   13. Patient is accompanied to CS theater by nurse/midwife.

   14. Transfer the patient by a stretcher lying in the lateral position to prevent supine hypotension.

   15. Auscultate fetal heart on OR table before the surgery.

   16. L&D Staff should attach the Hugs on baby’s ankle and bond with the Kisses (attach to Mother) prior shifting the baby to the nursery. At the same time, activate the Hugs and Kisses in the system by entering the name of the baby and the mother then transport to NICU / Nursery.

7. RESPONSIBILITY:

1. Obstetrics team with Midwife/ Nurses

2. Anesthesiologist  team

3. Pediatric team

8. FORMS/ EQUIPMENT:

1. Pre-Op Checklist

2. Informed  surgical consent

3. Physicians order

4. Notification of birth

5. New-born Identification

6. Hugs and Kisses devices

7. Camera to take photo of the baby

9. REFERENCE:

1. Oxford text reference in obstetrics and gynecology (2011)

2. Obstetrics and Gynecology, An evidence based text for MRCOG 3rd Edition  (2016)

10. REVISION: 

11. APPROVALS: