Managing Complications in Pregnancy and Childbirth: - IAWG

CAESAREAN SECTION P-43• Review for indications. Ensure that vaginal delivery is not possible.• Check for fetal life by listening to the fetal heart rate and examinefor fetal presentation.• Review operative care principles (page C-47).• Use local infiltration with lignocaine (page P-7), ketamine (page P-13), spinal anaesthesia (page P-11) or general anaesthesia:- Local anaesthesia is a safe alternative to general, ketamine orspinal anaesthesia when these anaesthetics or persons trainedin their use are not available;- The use of local anaesthesia for caesarean section requiresthat the provider counsel the woman and reassure herthroughout the procedure. The provider should useinstruments and handle tissue as gently as possible, keepingin mind that the woman is awake and alert.Note: In the case of heart failure, use local infiltration anaesthesiawith conscious sedation. Avoid spinal anaesthesia.• Start an IV infusion (page C-21).• Determine if a high vertical incision (page P-50) is indicated:- an inaccessible lower segment due to dense adhesions fromprevious caesarean sections;- transverse lie (with baby’s back down) for which a loweruterine segment incision cannot be safely performed;- fetal malformations (e.g. conjoined twins);- large fibroids over the lower segment;- a highly vascular lower segment due to placenta praevia;- carcinoma of the cervix.• If the baby’s head is deep down into the pelvis as in obstructedlabour, prepare the vagina for assisted caesarean delivery (page C-22).• Have the operating table tilted to the left or place a pillow or foldedlinen under the woman’s right lower back to decrease supinehypotension syndrome.