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CC BY 4.0 · Surg J (N Y) 2016; 02(01): e1-e6
DOI: 10.1055/s-0035-1570316
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evidence-Based Cesarean Delivery for the Nonobstetrician

Joshua D. Dahlke
1   Division of Maternal-Fetal Medicine, Nebraska Methodist Women's Hospital and Perinatal Center, Omaha, Nebraska, United States
,
Hector Mendez-Figueroa
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UT Health-University of Texas Medical School at Houston, Texas, United States
,
Jeffrey D. Sperling
3   Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, United States
,
Lindsay Maggio
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
,
Brendan D. Connealy
1   Division of Maternal-Fetal Medicine, Nebraska Methodist Women's Hospital and Perinatal Center, Omaha, Nebraska, United States
,
Suneet P. Chauhan
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UT Health-University of Texas Medical School at Houston, Texas, United States
› Author Affiliations
Further Information

Publication History

01 October 2015

16 October 2015

Publication Date:
18 December 2015 (online)

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Abstract

Cesarean delivery (CD) is one of the most common major surgeries performed in the United States and worldwide. Surgical techniques evaluated in well-designed randomized controlled trials (RCTs) that demonstrate maternal benefit should be incorporated into practice. The objective of this review is to provide a summary of surgical techniques of the procedure and review the evidence basis for them for the nonobstetrician. The following techniques with the strongest evidence should be commonly performed, when feasible: (1) prophylactic antibiotics with a single dose of ampicillin or first-generation cephalosporin prior to skin incision; (2) postpartum hemorrhage prevention with oxytocin infusion of 10 to 40 IU in 1 L crystalloid over 4 to 8 hours; (3) low transverse skin incision; (4) blunt or sharp subcutaneous and fascial expansion; (5) blunt, cephalad–caudad uterine incision expansion; (6) spontaneous placental removal; (7) blunt-tip needle usage during closure; (8) subcutaneous suture closure (running or interrupted) if thickness is ≥2 cm; and (9) skin closure with suture. Although the number of RCTs designed to optimize maternal and neonatal outcomes of this common procedure is encouraging, further work is needed to minimize surgical morbidity. Optimal methods for postpartum hemorrhage prevention, adhesion prevention, and venous thromboembolism prophylaxis remain ongoing areas of active research, with outcomes that could markedly improve maternal morbidity and mortality. If evidence of a surgical technique appears preferred over another, clinicians should be comfortable adopting the evidence-based technique when performing and teaching CD.

Keywords

cesarean delivery - surgical technique - evidence-based
 

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