Preparation for Emergency Cesarean section

1) Explain briefly and meaningfully to the patient regarding indication for emergency cesarean

2) Informed consent

3) Consent for blood transfusion

4) Paediatric referral to standby for delivery

5) Prophylactic antibiotic (IV cefoperazone 1 g+ IV metronidazole 500 mg stat)

• Some place may use IV ampicillin 1g +IV metronidazole 500mg stat

6) Prophylactic for acid aspiration (assume all patient take orally)

- IV ranitidine 50 mg stat

- IV maxalon 10 mg stat

- Oral citrate solution, 30 ml (0.3 molar)

7) Fill up the Emergency OT list. Crucial investigation are FBC+ BUSE and PT/aPTT if result already available.

8) Make sure that GXM of 2 unit whole blood readily available. Depending on pre op Hb, the total number of GXM may be increased.

9) Insert the CBD.

Post op plan for patient post Cesarean Section

For spinal analgesia

1) Keep patient lie flat till next review

2) V/S ½ hourly for 2H, then hourly till stable. After than 4 hourly.

3) Keep patient nil by mouth till next review

4) IV fluid maintenance 5 pints (2 pints D5%, 3 pints NS) / 24H

5) I/O chart

6) Pad chart

7) Keep CBD X 1/7

8) Wound inspection D2 (*some place, D3)

9) STO D7

10) S/C heparin 5000U B.D (6 hour post op till patient ambulate)

11) S/C Morphine 5 mg 4 hourly (*Some place may use suppositories voltaren)

12) IV antibiotic

- IV cefoperazone 1g BD

- IV metronidazole 500 mg t.d.s

13) Post op Hb (6 hour post op)

If patient under intra thecal analgesia

- Omit S/C morphine 5mg 4-Hrly

- Add IV piriton 10 mg t.d.s

- Add IV maxalon 10 mg t.d.s

If patient having blood loss more than 1000cc

- Withold S/C heparin until the result PT/aPTT come back and normal.

- FBC stat. To transfuse whole blood if Hb less than 8 or patient symptomatic.

- Double hematinic once patient tolerating orally