After cesarean delivery, early warning criteria are defined to facilitate timely diagnosis and treatment for women developing critical illness after delivery. Evidence on the clinical relevance of hemoglobin testing is limited. The rate of early breastfeeding is significantly lower after pre-labor cesarean delivery, compared with vaginal delivery. Early skin-to-skin contact appears to be associated with more women breastfeeding successfully and still breastfeeding at 1–4 months. Epidural morphine is significantly effective in reducing postpartum pain and increasing the time until the first request for a rescue analgesic. The use of NSAIDs is associated a significantly lower early pain scores, less opioid consumption, and less sedation. In obese women, oral cephalexin and metronidazole for 48 hours after delivery is associated with a significant decrease of surgical site infections within 30 days. ACOG suggests pneumatic compression devices before cesarean delivery and early mobilization after cesarean delivery for all women, and both mechanical and pharmacologic thromboprophylaxis for at least 6 weeks postpartum for women at high risk of VTE. Early oral feeding, gum chewing, early ambulation, and no placement or immediate removal of bladder catheter are all supported policies to advocate for an early recovery after obstetric surgery. The gold standard for the treatment of postpartum endometritis is the combination of clindamycin 900 mg IV every 8 hours plus gentamicin 5 mg/kg IV every 24 hours. Mild, non-purulent cellulitis without systemic signs of infection should be treated with antistreptococcal antimicrobial agents, while purulent drainage or exudates accompanying cellulitis need empiric therapy with adequate coverage for methicillin-resistant S. aureus. Early removal of the wound dressing at 6 hours instead of 24 hours is suggested, particularly after a scheduled cesarean delivery. It is preferable to reapproximate the skin with absorbable subcuticular suture rather than staples. Discharge at day 1 after elective cesarean delivery is a reasonable option compared with discharge at day 2. Women receiving non-opioid medications at discharge reported lower pain scores than those receiving also opioid agents.

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Care Post Cesarean Delivery

  • Elena Rita Magro Malosso,
  • Daniele Di Mascio

摘要

After cesarean delivery, early warning criteria are defined to facilitate timely diagnosis and treatment for women developing critical illness after delivery. Evidence on the clinical relevance of hemoglobin testing is limited. The rate of early breastfeeding is significantly lower after pre-labor cesarean delivery, compared with vaginal delivery. Early skin-to-skin contact appears to be associated with more women breastfeeding successfully and still breastfeeding at 1–4 months. Epidural morphine is significantly effective in reducing postpartum pain and increasing the time until the first request for a rescue analgesic. The use of NSAIDs is associated a significantly lower early pain scores, less opioid consumption, and less sedation. In obese women, oral cephalexin and metronidazole for 48 hours after delivery is associated with a significant decrease of surgical site infections within 30 days. ACOG suggests pneumatic compression devices before cesarean delivery and early mobilization after cesarean delivery for all women, and both mechanical and pharmacologic thromboprophylaxis for at least 6 weeks postpartum for women at high risk of VTE. Early oral feeding, gum chewing, early ambulation, and no placement or immediate removal of bladder catheter are all supported policies to advocate for an early recovery after obstetric surgery. The gold standard for the treatment of postpartum endometritis is the combination of clindamycin 900 mg IV every 8 hours plus gentamicin 5 mg/kg IV every 24 hours. Mild, non-purulent cellulitis without systemic signs of infection should be treated with antistreptococcal antimicrobial agents, while purulent drainage or exudates accompanying cellulitis need empiric therapy with adequate coverage for methicillin-resistant S. aureus. Early removal of the wound dressing at 6 hours instead of 24 hours is suggested, particularly after a scheduled cesarean delivery. It is preferable to reapproximate the skin with absorbable subcuticular suture rather than staples. Discharge at day 1 after elective cesarean delivery is a reasonable option compared with discharge at day 2. Women receiving non-opioid medications at discharge reported lower pain scores than those receiving also opioid agents.