n Obstetrics and Gynaecology Forum - Preparing for caesarean delivery : review




Caesarean delivery (CD) is associated with an almost three-fold higher risk of maternal death than vaginal delivery in South Africa. An emergency CD is associated with higher risks of severe bleeding and accidental injury to intra-abdominal organs (urinary bladder and bowel); as well as anaesthetic complications due to rapid induction of anaesthesia. The novice or inexperienced surgeon may be confronted with sudden difficulty during CD that, if not corrected within minutes, can lead to a maternal death or severe morbidity. In many cases it is (in retrospect) possible to predict the problematic operation. This article will guide doctors working in an obstetric service to make CD safer. Risk stratification in CD already begins at the antenatal clinic, where potential high-risk cases can be identified and referred before delivery. Morbid obesity or women with 2 or more previous CD are examples of cases where difficulty can be expected. During labour, women with a prolonged second stage, especially if there was an attempted (but failed) instrumental delivery; or women who develop pre-eclampsia at advanced labour are examples of cases where senior help should be requested. And then there are the situations where a woman with complications is too advanced in labour to refer, and the surgeon has to be able to deal with bleeding placenta praevia or CD for eclampsia at district level. The article further deals with the aspects of informed consent for CD as well as the WHO surgical safety checklist, a quality assurance tool to reduce morbidity and mortality. It can also be used to audit a CD service. It also encourages vital communication between the obstetrician, anaesthetist, scrub team and midwife.


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