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Maintaining Perioperative Normothermia in the Patient Undergoing Cesarean Delivery

Carpenter, Lavenia MD*; Baysinger, Curtis L. MD

Obstetrical & Gynecological Survey: July 2012 - Volume 67 - Issue 7 - p 436–446
doi: 10.1097/OGX.0b013e3182605ccd
CME PROGRAM
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CME

Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient’s core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completing this CME activity, obstetric care providers will better 1) assess the mechanisms involved in perioperative heat loss, 2) evaluate the literature support for reduction of perioperative hypothermia to reduce operative complications, and 3) evaluate the literature support of available methods for reduction of maternal and neonatal hypothermia during cesarean delivery.

*Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and †Associate Professor and Director, Division of Obstetric Anesthesia, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commerical organizations pertaining to this educational activity.

This work was supported by internal departmental resources of the Departments of Obstetric and Gynecology and Anesthesiology at Vanderbilt University.

Correspondence requests to: Lavenia Carpenter, MD, B1100 MCN, Department of Obstetrics and Gynecology, Medical Center North, Nashville, TN 37232. E-mail: lavenia.carpenter@vanderbilt.edu.

© 2012 Lippincott Williams & Wilkins, Inc.