Although I’ve been a proponent for prevention of medical errors for years and wrote a book to address those issues, I think my ob-gyn colleagues are finally catching on. Dr. Patrick Duff of the University of Florida’s Ob-Gyn department wrote an article in the December issue of the Obstetrics & Gynecology journal that caught my attention. In A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery, Duff outlines steps that obstetrician-gynecologists should take in order to reduce complications during and after a cesarean section. Duff patterns his list after Dr. Atul Gawande’s book, The Checklist Manifesto: How to Get it Right which has set the standard regarding reducing complications after surgery. According to Duff, the following steps should be taken in order to reduce complications after a cesarean section:
- Clip hair at the surgical site just before making the incision to reduce wound infections. Duff states that there is a greater chance of promoting infections when the hair is shaved the night before the procedure. He also recommends clipping hair as opposed to shaving which reduces the rate of would infections.
- Cleanse skin with chlorhexidine solution rather than iodine because medical studies have demonstrated a reduction in infections using chlorhexidine solution.
- Give broad spectrum antibiotics before the surgical incision as opposed to after the newborn’s umbilical cord is clamped.
- The placenta should not be removed by manual separation but by traction on the umbilical cord.
- Close the uterine incision in 2-layers rather than one. Although many ob-gyns prefer to close the uterine incision with one layer because it’s faster, medical studies have demonstrated that using the 2-layer method for closing the incision reduces the incidence of uterine rupture.
- Although rare, blood clots to the legs and lungs can occur after a cesarean section causing fatal results. Women who have a Basal Metabolic Index (BMI) of 30 or greater; women who severe varicose veins; women who have not moved in 4 days and those who have had illnesses such as sickle cell anemia, cancer, or hereditary thrombophilia should receive a blood thinner called heparin as well as compression stocking.
Although this article was written for obstetrician-gynecologists, it is imperative that patients become proactive regarding their medical care. It would not be unreasonable to discuss this list with your healthcare provider to determine exactly what surgical procedures and techniques they use. Sometimes our greatest teachers are our patients.
A healthy baby doesn’t just happen. It takes a smart mother who knows what to do.
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