Caesarean Section

Clinical Description

Delivery of the baby through an abdominal incision for maternal or fetal indication.

Signs and Symptoms

• The following clinical features may suggest an indication for referral for caesarean section: Cephalopelvic disproportion, breech presentation or any other malpresentation, fetal macrosomia, malposition, previous c-section delivery, history of myomectomy, fetal distress, failed induction of labour.

Management at the health Centre

• Refer to the Hospital
• Pre – referral management
• Insert a large intravenous cannula (preferably green or grey)
• Collect blood samples for FBC and group and cross match
• Commence IV Fluids (Normal saline or Ringer’s Lactate, but never 5% dextrose)
• Catheterize the patient
• Explain the findings to the patient

At District Hospital

• Preoperative management
• Prophylaxis: Give Cefazolin 2g IV STAT OR Ampicillin 1g IV STAT (30 min- 1hr before operation) OR Ceftriaxone 2g IV STAT if the other two drugs are unavailable
• Ensure FBC result to assess Hemoglobin level and platelet count.
• Get consent

Post-operative management

• Analgesia
• Opiates
• Pethidine 50 – 100 mg IM 4 hourly for 48 hours OR
• Morphine 5 – 10 mg IM 4 hourly for 48 hours
• NSAIDS
• Diclofenac suppository 100mg 12 hourly for 5 days OR
• Ibuprofen 400mg PO 8 hourly for 5 – 7 days
• Paracetamol 1g PO 6 hourly for 5 – 7 days
• Antibiotics
• INDICATIONS Offensive smelling liquor (Chorioamnionitis), prolonged surgery (> 2 hours), Massive blood loss (>1500mls), Surgical site contamination, prolonged labour with multiple vaginal examinations (≥ 6

VEs).

• 1st Line: Ampicillin 1g IV 8 hourly and Metronidazole 500mg IV 8 hourly for 5 days (or metronidazole 400mg PO 8 hourly for 5 days)
• Second line: Ceftriaxone 2g IV daily for 5 days and Metronidazole 500mg 8 hourly for 5 days (or Metronidazole 400mg PO 8 hourly for 5 days)
• Monitor for signs of sepsis throughout the postoperative stay. Provide Routine post-operative wound care