Pearls on cesarean

Even with its recent decline in occurrence, cesarean delivery remains the most frequently performed surgical procedure in the United States, accounting for approximately 21.5% of all deliveries. Here, obstetricians from across the country share pearls on various aspects of cesarean birth.

The difficult cesarean. When a difficult cesarean is predicted and the threat of obstetrical hemorrhage is imminent, I recommend that clinicians position the patient in low Allen stirrups, using a drape that provides vaginal access. This allows for proper elevation of the fetal head and better assessment of potential blood loss. Make sure a hysterectomy instrument tray is nearby and an experienced gynecologic scrub nurse is available. These steps should eliminate occult hemorrhage and allow for rapid response to any changes in the patient’s clinical status. —Richard Hill, MD, Kansas City, Mo