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Cesarean delivery

Key sources
The following summarized guidelines for the management of cesarean delivery are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022; 2021; 2020; 2018; 2017), the American College of Obstetricians and Gynecologists (ACOG 2021; 2020; 2019; 2018; 2017), the American Heart Association (AHA 2020), the Royal College of Obstetricians and Gynaecologists (RCOG 2019; 2015; 2012), the Enhanced Recovery After Surgery Society (ERASS 2018), the World Health Organization (WHO 2018; 2015), the Society for Maternal-Fetal Medicine (SMFM 2015), the American College of Obstetricians and Gynecologists (ACOG/SMFM 2014), and the American College of Chest Physicians (ACCP 2012).
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Guidelines

1.Perioperative care

Preoperative antibiotic prophylaxis: as per ERASS 2018 guidelines, administer IV antibiotics routinely within 60 minutes before the Cesarean delivery skin incision. Administer a first-generation cephalosporin in all females. Consider adding azithromycin for additional reduction in postoperative infections in females in labor or withRuptured membranes.
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  • Perioperative thromboprophylaxis

  • Perioperative fluid management

  • Intraoperative prevention of hypothermia

2.Surgical interventions

Indications for Cesarean delivery, macrosomia, RCOG: perform elective Cesarean delivery to reduce the potential morbidity for pregnancies complicated by preexisting or gestational diabetes, regardless of treatment, with an estimated fetal weight of > 4,500 g.
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  • Indications for Cesarean delivery (vasa previa)

  • Indications for Cesarean delivery (placenta previa)

  • Indications for Cesarean delivery (placenta accrete)

  • Indications for Cesarean delivery (resuscitative hysterotomy)

  • Indications for Cesarean delivery (maternal request)

  • Choice of anesthesia

  • Technical considerations for Cesarean delivery (field preparation)

  • Technical considerations for Cesarean delivery (incision)

  • Technical considerations for Cesarean delivery (closure)

3.Preventative measures

Primary prevention of Cesarean delivery, first stage of labor: do not perform Cesarean delivery based on a prolonged latent phase (such as > 20 hours in nulliparous females and > 14 hours in multiparous females).
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  • Primary prevention of Cesarean delivery (second stage of labor)

  • Primary prevention of Cesarean delivery (fetal conditions)

  • Primary prevention of Cesarean delivery (maternal factors)

  • Primary prevention of Cesarean delivery (twin gestation)

  • Primary prevention of Cesarean delivery (policies)

  • Primary prevention of Cesarean delivery (induction of labor)

4.Follow-up and surveillance

Immediate care of the newborn at delivery, cord clamping, SOGC: delay cord clamping for 60-120 seconds in both preterm (< 37 weeks) and extremely preterm (< 28 weeks) singletons because it decreases newborn mortality and morbidity and improves hematological outcomes after the neonatal period. Delay cord clamping for at least 30 seconds over clamping immediately when cord clamping cannot be deferred for a full 60-120 seconds. Delay cord clamping with the infant at the level of the Cesarean incision.
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  • Immediate care of the newborn at delivery (supportive care)

  • Immediate care of the newborn at delivery (vaginal seeding)

  • Vaginal birth after Cesarean delivery (indications for trial of labor)

  • Vaginal birth after Cesarean delivery (setting of care)

  • Vaginal birth after Cesarean delivery (antenatal counseling)

  • Vaginal birth after Cesarean delivery (technical considerations)

  • Management of Cesarean scar pregnancy