10 practical, evidence-based recommendations for improving maternal outcomes of cesarean delivery
OBG Management, 03/02/2012
Sibai BM – These studies suggest that planning and antenatal consultation with anesthesiologists are important to help avert anesthetic complications during cesarean delivery. Requirements include detailed evaluation at admission, early placement of an epidural catheter, preparation for general anesthesia in case of failure of regional anesthesia, and ensuring the availability of an anesthesiologist who has expertise in this population.
Cesarean delivery is not risk–free, despite its high prevalence (30% overall, but almost 100% in women who have more than two prior cesareans).
It increases the risks of adhesions, severe blood loss, and injury to the bowel, bladder and ureters, particularly among women undergoing the procedure for the second or third time.
Morbidly obese women (i.e., those who have a body mass index [BMI] of 40 or above) are in a particular bind.
They have an elevated risk of cesarean delivery, and when they undergo the procedure, they have a significantly heightened risk of cardiopulmonary complications, anesthetic complications, wound complications, thromboembolism, and prolonged skin incision–to–delivery time.
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