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A Simple Checklist for Preventing Major Complications Associated With Cesarean Delivery

Duff, Patrick MD

doi: 10.1097/AOG.0b013e3181fae763
Current Commentary

I propose a simple, evidence-based, eight-item checklist that, if followed, should reduce the frequency of many of the most serious complications associated with cesarean delivery: endometritis, wound infection, wound disruption, thrombophlebitis, and uterine scar dehiscence in a subsequent pregnancy. The frequency of abdominal wound infections can be reduced significantly by using electric clippers, rather than a razor, to remove the hair at the site of the surgical incision, washing the skin with a chlorhexidine solution, and administering broad-spectrum antibiotic prophylaxis before the start of surgery rather than after the neonate's umbilical cord has been clamped. Administration of broad-spectrum antibiotic prophylaxis and removal of the placenta by traction on the umbilical cord, rather than by manual extraction, will reduce the frequency of postcesarean endometritis. Closure of the uterine incision in two layers rather than one will significantly reduce the frequency of scar dehiscence in a subsequent pregnancy. Closure of the deep subcutaneous layer in patients whose subcutaneous tissue is greater than 2 cm in thickness will significantly reduce the risk of seroma, hematoma, and subsequent wound disruption. Institution of appropriate prophylaxis for deep vein thrombosis in intermediate and high-risk patients will reduce the risk of subsequent thromboembolic events.

Adherence to a simple eight-item checklist will reduce the frequency of many of the most serious complications after cesarean delivery.

From the Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida.

Corresponding author: Patrick Duff, MD, Department of Obstetrics and Gynecology, University of Florida, PO Box 100294, Gainesville, FL 32610; e-mail: duffp@ufl.edu.

Financial Disclosure The author did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.