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Cesarean delivery: Preoperative issues

Author
Vincenzo Berghella, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Cesarean delivery (also called cesarean section and cesarean birth) refers to the delivery of a baby through surgical incisions in the abdomen and uterus. Cesarean deliveries are categorized as either primary (ie, first cesarean delivery) or repeat (ie, after a previous cesarean birth). The total cesarean delivery rate is the sum of these two components.

This topic will review preoperative issues relating to cesarean delivery. Surgical technique, postoperative issues, repeat cesarean delivery, and trial of labor after cesarean delivery are discussed separately:

(See "Cesarean delivery: Technique".)

(See "Cesarean delivery: Postoperative issues".)

(See "Repeat cesarean delivery".)

                             

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 29 00:00:00 GMT+00:00 2016.
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References
Top
  1. Boyle A, Reddy UM, Landy HJ, et al. Primary cesarean delivery in the United States. Obstet Gynecol 2013; 122:33.
  2. Walker SP, McCarthy EA, Ugoni A, et al. Cesarean delivery or vaginal birth: a survey of patient and clinician thresholds. Obstet Gynecol 2007; 109:67.
  3. Lyerly AD, Mitchell LM, Armstrong EM, et al. Risks, values, and decision making surrounding pregnancy. Obstet Gynecol 2007; 109:979.
  4. American College of Obstetricians and Gynecologists. Patient Safety Checklist no. 4: preoperative planned cesarean delivery. Obstet Gynecol 2011; 118:1471.
  5. American College of Obstetricians and Gynecologists. Patient Safety Checklist no. 3: scheduling planned cesarean delivery. Obstet Gynecol 2011; 118:1469.
  6. American College of Obstetricians and Gynecologists and American Academy of Pediatrics. Guidelines For Perinatal Care, 7th ed, 2012.
  7. Sentilhes L, Vayssière C, Beucher G, et al. Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2013; 170:25.
  8. http://www.nice.org.uk/guidance/cg132 (Accessed on October 22, 2014).
  9. Stutchfield P, Whitaker R, Russell I, Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ 2005; 331:662.
  10. Zanardo V, Padovani E, Pittini C, et al. The influence of timing of elective cesarean section on risk of neonatal pneumothorax. J Pediatr 2007; 150:252.
  11. Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ 2008; 336:85.
  12. Zanardo V, Simbi AK, Franzoi M, et al. Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr 2004; 93:643.
  13. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102:101.
  14. Wax JR, Herson V, Carignan E, et al. Contribution of elective delivery to severe respiratory distress at term. Am J Perinatol 2002; 19:81.
  15. Yee W, Amin H, Wood S. Elective cesarean delivery, neonatal intensive care unit admission, and neonatal respiratory distress. Obstet Gynecol 2008; 111:823.
  16. Clark SL, Miller DD, Belfort MA, et al. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol 2009; 200:156.e1.
  17. Wilmink FA, Hukkelhoven CW, Lunshof S, et al. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol 2010; 202:250.e1.
  18. Nir V, Nadir E, Feldman M. Late better than early elective term Cesarean section. Acta Paediatr 2012; 101:1054.
  19. Glavind J, Kindberg SF, Uldbjerg N, et al. Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2013; 120:1123.
  20. Cousins LM, Teplick FB, Poeltler DM. Pre-cesarean blood bank orders: a safe and less expensive approach. Obstet Gynecol 1996; 87:912.
  21. Ransom SB, Fundaro G, Dombrowski MP. Cost-effectiveness of routine blood type and screen testing for cesarean section. J Reprod Med 1999; 44:592.
  22. Rouse DJ, MacPherson C, Landon M, et al. Blood transfusion and cesarean delivery. Obstet Gynecol 2006; 108:891.
  23. American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007; 106:843.
  24. Chua SC, Joung SJ, Aziz R. Incidence and risk factors predicting blood transfusion in caesarean section. Aust N Z J Obstet Gynaecol 2009; 49:490.
  25. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014; :CD007482.
  26. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
  27. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2011; 117:1472.
  28. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
  29. Pevzner L, Swank M, Krepel C, et al. Effects of maternal obesity on tissue concentrations of prophylactic cefazolin during cesarean delivery. Obstet Gynecol 2011; 117:877.
  30. Gyte GM, Dou L, Vazquez JC. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Rev 2014; :CD008726.
  31. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev 2000; :CD001136.
  32. Mackeen AD, Packard RE, Ota E, et al. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev 2014; :CD009516.
  33. Dinsmoor MJ, Gilbert S, Landon MB, et al. Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery. Obstet Gynecol 2009; 114:752.
  34. Ledger WJ, Blaser MJ. Are we using too many antibiotics during pregnancy? BJOG 2013; 120:1450.
  35. Andrews WW, Hauth JC, Cliver SP, et al. Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstet Gynecol 2003; 101:1183.
  36. Tita AT, Hauth JC, Grimes A, et al. Decreasing incidence of postcesarean endometritis with extended-spectrum antibiotic prophylaxis. Obstet Gynecol 2008; 111:51.
  37. Tita AT, Owen J, Stamm AM, et al. Impact of extended-spectrum antibiotic prophylaxis on incidence of postcesarean surgical wound infection. Am J Obstet Gynecol 2008; 199:303.e1.
  38. Tita AT, Szychowski JM, Boggess K, et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med 2016; 375:1231.
  39. Weinstein RA, Boyer KM. Antibiotic Prophylaxis for Cesarean Delivery - When Broader Is Better. N Engl J Med 2016; 375:1284.
  40. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2013; :CD001058.
  41. Zelenitsky SA, Silverman RE, Duckworth H, Harding GK. A prospective, randomized, double-blind studyof single high dose versus multiple standard dose gentamicin both in combination withmetronidazole for colorectal surgicalprophylaxis. J Hosp Infect 2000; 46:135.
  42. Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999; 353:1258.
  43. Bain E, Wilson A, Tooher R, et al. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2014; :CD001689.
  44. Kamel H, Navi BB, Sriram N, et al. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014; 370:1307.
  45. Seeho S, Nassar N. Thromboprophylaxis after caesarean: when even the 'experts' disagree. BJOG 2016; 123:2163.
  46. James A, Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 123: thromboembolism in pregnancy. Obstet Gynecol 2011; 118:718.
  47. Clark SL, Belfort MA, Dildy GA, et al. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008; 199:36.e1.
  48. Clark SL, Christmas JT, Frye DR, et al. Maternal mortality in the United States: predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage. Am J Obstet Gynecol 2014; 211:32.e1.
  49. Committee on Practice Bulletins--Gynecology, American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 84: Prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol 2007; 110:429.
  50. Sibai BM, Rouse DJ. Pharmacologic Thromboprophylaxis in Obstetrics: Broader Use Demands Better Data. Obstet Gynecol 2016; 128:681.
  51. Overcash RT, Somers AT, LaCoursiere DY. Enoxaparin dosing after cesarean delivery in morbidly obese women. Obstet Gynecol 2015; 125:1371.
  52. SMFM, Publication Committe, with Varner MW. Thromboprophylaxis for cesarean delivery. Contemp Ob Gyn 2011; 6:30.
  53. Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e691S.
  54. Dargaud Y, Rugeri L, Vergnes MC, et al. A risk score for the management of pregnant women with increased risk of venous thromboembolism: a multicentre prospective study. Br J Haematol 2009; 145:825.
  55. Danilenko-Dixon DR, Heit JA, Silverstein MD, et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study. Am J Obstet Gynecol 2001; 184:104.
  56. Ettema HB, Kollen BJ, Verheyen CC, Büller HR. Prevention of venous thromboembolism in patients with immobilization of the lower extremities: a meta-analysis of randomized controlled trials. J Thromb Haemost 2008; 6:1093.
  57. Jacobsen AF, Skjeldestad FE, Sandset PM. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 2008; 6:905.
  58. James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194:1311.
  59. Lindqvist P, Dahlbäck B, Marŝál K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999; 94:595.
  60. Macklon NS, Greer IA. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience. Scott Med J 1996; 41:83.
  61. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RD. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 2001; 108:56.
  62. Blondon M, Perrier A, Nendaz M, et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103:129.
  63. Kobayashi T, Nakabayashi M, Ishikawa M, et al. Pulmonary thromboembolism in obstetrics and gynecology increased by 6.5-fold over the past decade in Japan. Circ J 2008; 72:753.
  64. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. Green-top Guideline No. 37a. April 2015 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf (Accessed on October 05, 2016).
  65. Committee on Obstetric Practice. ACOG Committee Opinion No. 382: Fetal Monitoring Prior to Scheduled Cesarean Delivery. Obstet Gynecol 2007; 110:961.
  66. Abdel-Aleem H, Aboelnasr MF, Jayousi TM, Habib FA. Indwelling bladder catheterisation as part of intraoperative and postoperative care for caesarean section. Cochrane Database Syst Rev 2014; :CD010322.
  67. Li L, Wen J, Wang L, et al. Is routine indwelling catheterisation of the bladder for caesarean section necessary? A systematic review. BJOG 2011; 118:400.
  68. Senanayake H. Elective cesarean section without urethral catheterization. J Obstet Gynaecol Res 2005; 31:32.
  69. Ghoreishi J. Indwelling urinary catheters in cesarean delivery. Int J Gynaecol Obstet 2003; 83:267.
  70. Barnes JS. Is it better to avoid urethral catheterization at hysterectomy and caesarean section? Aust N Z J Obstet Gynaecol 1998; 38:315.
  71. Nasr AM, ElBigawy AF, Abdelamid AE, et al. Evaluation of the use vs nonuse of urinary catheterization during cesarean delivery: a prospective, multicenter, randomized controlled trial. J Perinatol 2009; 29:416.
  72. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev 2011; :CD004122.
  73. Lefebvre A, Saliou P, Lucet JC, et al. Preoperative hair removal and surgical site infections: network meta-analysis of randomized controlled trials. J Hosp Infect 2015; 91:100.
  74. Tuuli MG, Liu J, Stout MJ, et al. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery. N Engl J Med 2016; 374:647.
  75. Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med 2010; 362:18.
  76. Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980; 60:27.
  77. Hayek LJ, Emerson JM, Gardner AM. A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates. J Hosp Infect 1987; 10:165.
  78. Rotter ML, Hirschl AM, Koller W. Effect of chlorhexidine-containing detergent, non-medicated soap or isopropanol and the influence of neutralizer on bacterial pathogenicity. J Hosp Infect 1988; 11:220.
  79. Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2006; :CD004985.
  80. Haas DM, Morgan S, Contreras K. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev 2014; :CD007892.
  81. American College of Obstetricians and Gynecologists Women's Health Care Physicians, Committee on Gynecologic Practice. Committee Opinion No. 571: Solutions for surgical preparation of the vagina. Obstet Gynecol 2013; 122:718.
  82. WHO recommendations for prevention and treatment of maternal peripartum infections. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/peripartum-infections-brief/en/ (Accessed on November 03, 2015).
  83. Pitt C, Sanchez-Ramos L, Kaunitz AM. Adjunctive intravaginal metronidazole for the prevention of postcesarean endometritis: a randomized controlled trial. Obstet Gynecol 2001; 98:745.
  84. Cordtz T, Schouenborg L, Laursen K, et al. The effect of incisional plastic drapes and redisinfection of operation site on wound infection following caesarean section. J Hosp Infect 1989; 13:267.
  85. Ward HR, Jennings OG, Potgieter P, Lombard CJ. Do plastic adhesive drapes prevent post caesarean wound infection? J Hosp Infect 2001; 47:230.
  86. Lee SW, Khaw KS, Ngan Kee WD, et al. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. Br J Anaesth 2012; 109:950.
  87. Bamber JH, Dresner M. Aortocaval compression in pregnancy: the effect of changing the degree and direction of lateral tilt on maternal cardiac output. Anesth Analg 2003; 97:256.
  88. Kundra P, Velraj J, Amirthalingam U, et al. Effect of positioning from supine and left lateral positions to left lateral tilt on maternal blood flow velocities and waveforms in full-term parturients. Anaesthesia 2012; 67:889.
  89. Kinsella SM, Harvey NL. A comparison of the pelvic angle applied using lateral table tilt or a pelvic wedge at elective caesarean section. Anaesthesia 2012; 67:1327.
  90. Calvache JA, Muñoz MF, Baron FJ. Hemodynamic effects of a right lumbar-pelvic wedge during spinal anesthesia for cesarean section. Int J Obstet Anesth 2011; 20:307.
  91. Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev 2013; :CD007623.
  92. Lagrew DC, Bush MC, McKeown AM, Lagrew NG. Emergent (crash) cesarean delivery: indications and outcomes. Am J Obstet Gynecol 2006; 194:1638.
  93. MacKenzie IZ, Cooke I. Prospective 12 month study of 30 minute decision to delivery intervals for "emergency" caesarean section. BMJ 2001; 322:1334.
  94. ACOG Committee on Obstetric Practice. ACOG committee opinion No. 433: optimal goals for anesthesia care in obstetrics. Obstet Gynecol 2009; 113:1197.
  95. James D. Caesarean section for fetal distress. BMJ 2001; 322:1316.
  96. Helmy WH, Jolaoso AS, Ifaturoti OO, et al. The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target? BJOG 2002; 109:505.
  97. Tuffnell DJ, Wilkinson K, Beresford N. Interval between decision and delivery by caesarean section-are current standards achievable? Observational case series. BMJ 2001; 322:1330.
  98. Chauhan SP, Roach H, Naef RW 2nd, et al. Cesarean section for suspected fetal distress. Does the decision-incision time make a difference? J Reprod Med 1997; 42:347.
  99. MacKenzie IZ, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries. BJOG 2002; 109:498.
  100. Thomas J, Paranjothy S, James D. National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ 2004; 328:665.
  101. Holcroft CJ, Graham EM, Aina-Mumuney A, et al. Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans. J Perinatol 2005; 25:229.
  102. Bloom SL, Leveno KJ, Spong CY, et al. Decision-to-incision times and maternal and infant outcomes. Obstet Gynecol 2006; 108:6.
  103. Tolcher MC, Johnson RL, El-Nashar SA, West CP. Decision-to-incision time and neonatal outcomes: a systematic review and meta-analysis. Obstet Gynecol 2014; 123:536.
  104. Stallings SP, Edwards RK, Johnson JW. Correlation of head-to-body delivery intervals in shoulder dystocia and umbilical artery acidosis. Am J Obstet Gynecol 2001; 185:268.
  105. Katz VL, Dotters DJ, Droegemueller W. Perimortem cesarean delivery. Obstet Gynecol 1986; 68:571.
  106. Myers RE. Two patterns of perinatal brain damage and their conditions of occurrence. Am J Obstet Gynecol 1972; 112:246.
  107. Smith J, Plaat F, Fisk NM. The natural caesarean: a woman-centred technique. BJOG 2008; 115:1037.
  108. Magee SR, Battle C, Morton J, Nothnagle M. Promotion of family-centered birth with gentle cesarean delivery. J Am Board Fam Med 2014; 27:690.
  109. ACOG Task Force on Cesarean Delivery Rates. Evaluation of cesarean delivery, American College of Obstetricians and Gynecologists, Washington, DC 2000.
  110. National Institute for Health and Clinical Excellence (NICE). Caesarean section. http://guidance.nice.org.uk/cg132 (Accessed on January 23, 2012).