Document Detail

A simple checklist for preventing major complications associated with cesarean delivery.
MedLine Citation:
PMID:  21099608     Owner:  NLM     Status:  MEDLINE    
I propose a simple, evidence-based, eight-item checklist that, if followed, should reduce the frequency of many of the most serious complications associated with cesarean delivery: endometritis, wound infection, wound disruption, thrombophlebitis, and uterine scar dehiscence in a subsequent pregnancy. The frequency of abdominal wound infections can be reduced significantly by using electric clippers, rather than a razor, to remove the hair at the site of the surgical incision, washing the skin with a chlorhexidine solution, and administering broad-spectrum antibiotic prophylaxis before the start of surgery rather than after the neonate's umbilical cord has been clamped. Administration of broad-spectrum antibiotic prophylaxis and removal of the placenta by traction on the umbilical cord, rather than by manual extraction, will reduce the frequency of postcesarean endometritis. Closure of the uterine incision in two layers rather than one will significantly reduce the frequency of scar dehiscence in a subsequent pregnancy. Closure of the deep subcutaneous layer in patients whose subcutaneous tissue is greater than 2 cm in thickness will significantly reduce the risk of seroma, hematoma, and subsequent wound disruption. Institution of appropriate prophylaxis for deep vein thrombosis in intermediate and high-risk patients will reduce the risk of subsequent thromboembolic events.
Patrick Duff
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Publication Detail:
Type:  Editorial    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  116     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-04     Revised Date:  2011-03-29    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1393-6     Citation Subset:  AIM; IM    
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MeSH Terms
Cesarean Section* / adverse effects,  methods
Endometritis / etiology,  prevention & control
Postoperative Care
Postoperative Complications / prevention & control*
Preoperative Care
Surgical Wound Dehiscence / prevention & control
Surgical Wound Infection / prevention & control
Thrombophlebitis / etiology,  prevention & control
Comment In:
Obstet Gynecol. 2011 Mar;117(3):732; author reply 732   [PMID:  21343785 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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