Caesarean Section
Preparation Steps
1. Review indications. Check fetal presentation and ensure that vaginal delivery is not possible.
2. Obtain consent from the patient after explaining the procedure and the reason for it.
3. Check the patient’s haemoglobin concentration, but do not wait for the result if there is fetal or maternal distress or danger. Send the blood sample for type and screen. If the patient is severely anaemic, plan to give two units of blood.
4. Start an IV infusion.
5. Give sodium citrate 30 ml 0.3 molar and/or ranitidine 150 mg orally or 50 mg IV to reduce stomach acidity. Sodium citrate works for 20 minutes only so should be given immediately before induction of anaesthesia if a general anaesthetic is given.
6. Catheterize the bladder and keep a catheter in place during the operation.
7. If the baby’s head is deep down into the pelvis, as in obstructed labour, prepare the vagina for assistance at caesarean delivery.
8. Roll the patient 15° to her left or place a pillow under her right hip to decrease supine hypotension.
9. Listen to the fetal heart rate before beginning surgery.