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Cesarean section 

Cesarean section
Chapter:
Cesarean section
Author(s):

Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

DOI:
10.1093/med/9780192631732.003.0042
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date: 23 October 2019

Maternal morbidity after cesarean section has not been studied as systematically as the maternal mortality associated with the operation, but the problem is undoubtedly substantial. Febrile morbidity, caused by postoperative infection or by other factors, appears to follow cesarean section in at least one in five women. Serious infections, such as pelvic abscess, septic shock, and septic pelvic vein thrombophlebitis, are not rare. The first step toward reducing the infectious morbidity that is so common after cesarean section is to minimize the number of unnecessary operations. The second step requires attention to the many factors that reduce the risk of infection when the operation is justified, such as: minimizing the length of hospital admission before surgery; delaying shaving of the operation site until immediately before the operation; sterilizing swabs, instruments, the gloves worn by the operating team; cleaning the skin of the woman; air exchanges in the operating theatre; and paying attention to good surgical technique. The potential for prophylactic antibiotics to reduce maternal morbidity after cesarean section has by now been investigated systematically. The benefits have been unequivocally demonstrated. Although the extent to which toxic or allergic effects of antibiotics may cause maternal morbidity is not well established, the information that is available provides clear guidelines for practice.

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