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Ceasarian Section LSCS

Management Of Caesarian Patient

Caesarian Section

A caesarian section, or cesarean section, is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus.

Purpose of Caesarian Section

  • The purpose is to standardize communication and terminology in the management of cesarean sections between providers and nursing.
  • To give guidelines to ensure safe delivery needs of mother and the newborn with cesarean sections.

Scope of Caesarian Section

Patient who has undergone through lower segment of caesarian section (L.S.C.S.).

Definition-Caesarian Section

A Surgical incision through the abdominal wall and uterus, performed to deliver a fetus.

Applicable Areas

Gyneac & Obstetric Department.

Responsibility

Consultant, Medical Officer, Staff Nurse, Auxillary Nurse Midwife and Head Nurse.

Procedure

Pre-Operative

  • Collect history of the patient.
  • Send blood for ANC investigation profile, if not done.
  • Ensure adequate blood is cross-matched and kept ready.
  • Obtain written consent from the patient and spouse / relative / witness as the case may be.
  • Ensure O.T. booking is done.
  • Carry out pre-operative order as advised :
  • Shave and prepare from umbilicus to thigh and private part.
  • Give simple / Proctolysis enema as per gynecologist’s order and observe the result.
  • Keep patient for NBM at least for 6 hours.
  • Give pre-medications as ordered.
  • Insert Foleys catheter before shifting to O.T.
  • Ensure that I.D. band is applied on the wrist as well as valuables are removed.
  • Provide O.T. gown.

Post- Operative

  • Check abdominal girth as follows :
  • First 2 hours –     every half an hour.
  • Next 4 hours –     every one hour.
  • Next 8 hours –     every two hours.
  • Change pads after every 4 hours and in-between, if necessary.
  • Remove Foley’s catheter as instructed.
  • Ambulate patient to bathroom on 2nd
  • Change wound dressing as per the instructions of gynecologist.
  • Assist for removal of sutures as per the instructions of gynecologist.

Documentation

Nurse’s Observation Sheet.

Notes

Availability of Staff and Physician

  • Should be readily available within 30 minutes from decision to incision.
  • Should be immediately available within 10-15 minutes from decision to incision.

Levels and examples of urgency of cesarean section

  • The examples listed below do not override the decision of the physician.
  • Start Cesarean Section – Immediate Cesarean. Less than 30 minutes from decision to incision.  Example, life threatening events affecting the fetus or the mother, prolapsed cord, uterine rupture, fetal bradycardia unresponsive to intrauterine resuscitation efforts.
  • Emergency Cesarean Section – Cesarean takes precedence over other cases. 30-40 minutes decision to incision. Examples : Non-reassuring fetal heart rate pattern, failed vacuum or forceps delivery, breech presentation in labor, failure to progress in labor with non-reassuring fetal heart rate.
  • Urgent Cesarean Section – Less than 60 minutes from decision to incision. Cesarean may not take precedence over other cases.  Example:  Repeat cesarean section in labor, breech with intact membranes, failure to progress with stable fetal heart rate.
  • Unscheduled Cesarean Section – Cesarean Section as soon as practitioner, room and staff are available. Will not typically take precedence over other scheduled Cesarean Sections.  Example : Previous Cesarean with ruptured membranes, repeat cesarean in early labor, failed induction not in labor, patient request.
  • Scheduled Cesarean Section – Previously scheduled at a designated time when practitioner staff and room available.