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Routine antibiotics at cesarean section to reduce infection

Women undergoing cesarean section have a five to 20‐fold greater chance of getting an infection compared with women who give birth vaginally. These infections can be in the organs within the pelvis, around the surgical incision and sometimes the urine. The infections can be serious, and very occasionally can lead to the mother’s death. The potential benefits of reducing infection for the mother need to be balanced against any adverse effects such as nausea, vomiting, skin rash and rarely allergic reactions in the mother, and any effect of antibiotics on the baby, including thrush. This review looked at whether antibiotics are effective in preventing infection in women having a cesarean section. It also studied the effect of giving the antibiotics before or after the cord is clamped and different kinds of antibiotics. The review found 95 studies involving over 15,000 women. Routine use of antibiotics at cesarean section reduced the risk of wound and womb infections in mothers as well as the risk of serious complications of infections for the mothers by 60% to 70%. This was so whether the cesarean section was planned (elective) or not, and whether the antibiotics were given before or after clamping of the umbilical cord. The evidence to support antibiotic treatment was of moderate quality but often the way the study was done was not described well enough. None of the studies looked properly at possible adverse effects on the baby and so, although there are benefits for the mother, there is some uncertainty about whether there are any important effects on the baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Mother and baby outcomes following normal delivery and caesarean (c‐section) delivery in women with bleeding disorders and carriers

We looked at the evidence on mother and baby outcomes following natural vaginal delivery and caesarean (c‐section) section in women with bleeding disorders and carriers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. Both forms of care have benefits and risks associated with them. There were two small trials available but there are limited data to help women, their partners and their caregivers make this choice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Use of wound drains after caesarean section

Women who have a caesarean section operation (removing the baby by surgery through the mother's abdomen) sometimes have a wound drain put in place. A surgical drain is a tube used to remove pus, blood or other fluids from a wound. The review did not find any differences in the risk of wound infection or other post operative complications between women who had wound drains compared with those who did not.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission

No good evidence to support using caesarean section for reducing mother to baby transmission of hepatitis C during labour and birth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Trial of instrumental birth in theatre versus immediate caesarean section for anticipated difficult assisted births

Most women give birth spontaneously, but some need assistance during the second stage of labour with obstetric forceps or the vacuum. The rates of instrumental vaginal births range from 5% to 20% of all births in high‐income countries, with little information about the incidence in low‐income countries. Indications for instrumental vaginal births are generally fetal heart rate abnormalities, poor position of the baby, maternal exhaustion and some maternal medical conditions such as heart disease. The majority of instrumental vaginal births are conducted in the delivery room, but in a small proportion of anticipated difficult births (2% to 5%), a trial of instrumental vaginal birth is conducted in theatre with preparations made for proceeding to caesarean section. It has been suggested that for these anticipated difficult assisted vaginal births, it may be preferable to go straight to caesarean section. The advantage of doing an immediate caesarean section would be a reduced risk of morbidity for both mother and baby from a failed attempted instrumental birth. However, the disadvantages of routinely doing a caesarean section in these circumstances are an increased risk of morbidity from caesarean section which often manifests itself at a subsequent birth. The review of trials looking at attempted instrumental delivery in theatre versus immediate caesarean section for anticipated difficult births identified no trials to help with making this decision. Further research is clearly needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Spinal versus epidural anaesthesia for caesarean section

Effective regional anaesthesia for caesarean section can be achieved by both spinal or epidural techniques.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Caesarean section for non‐medical reasons at term

Childbirth is a profound and powerful human experience. Women often describe feelings of empowerment, elation and achievement, although other women's experiences include trauma, fear, pain, and loss of control. The way women give birth, either vaginally or by caesarean section, is likely to impact on their feelings. In recent years, caesareans have become safer due to improved anaesthesia and improved surgical techniques, along with the routine use of drugs at surgery to combat the increased risk of infection and blood clots in the mother. However, caesarean section remains a surgical procedure accompanied by abdominal and uterine incisions, scarring and adhesions. There is also evidence of an increased chance of problems in subsequent pregnancies for both women and babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Techniques and materials for closure of the abdominal wall in caesarean section

There is not enough evidence to say whether particular techniques for closing the abdominal wall during caesarean section are better than others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Early compared with delayed oral fluids and food after caesarean section

Drinking and eating again soon after caesarean section does not seem to cause women any problems, and may even speed recovery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Extra‐abdominal versus intra‐abdominal repair of the uterine incision at caesarean section

There is not enough evidence to say if closing the cut in the womb after caesarean section is better done within the abdomen or outside.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

A package of care to actively manage labour in women who are at low risk of complications to reduce caesarean section rates

Many countries have an increasing rate of caesarean section. Higher rates do not always give additional health gains and they can increase maternal risks and affect subsequent pregnancies. Active management of labour has been proposed to reduce the number of caesarean births. Active management includes routine amniotomy (artificial rupture of the membranes), strict rules for diagnosing slow progress, use of the intravenous drug oxytocin to increase contractions of the uterus and one‐to‐one care. The disadvantages of active management are that it can possibly lead to more invasive monitoring, more interventions and a more medicalised birth in which women have less control and less satisfaction. The review included seven trials involving 5390 women. These studies show that women who received active management were slightly less likely to have a caesarean section and were more likely to have shorter labours (less than 12 hours). There was no difference in the number of assisted deliveries, nor was there any difference in complications for mothers or their babies when comparing women in the active management group with those receiving routine care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Placenta delivery at caesarean section

There are various methods of delivery of placenta at caesarean section. These include placental drainage with spontaneous delivery, cord traction and manual removal. The last two methods: cord traction (usually combined with massage or expression of the uterus) and manual removal are frequently used. The review identified 15 studies involving 4694 women. Delivery of the placenta by cord traction at caesarean section has more advantages compared to manual removal. These are less endometritis; less blood loss; less decrease in haematocrit levels postoperatively; and shorter duration of hospital stay.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Techniques for caesarean section

Caesarean sections are performed as both elective and urgent procedures and the rates are rising. The major complications are intraoperative damage to organs, anaesthetic complications, bleeding, infection and thromboembolism. The techniques used vary considerably. Available evidence from randomised controlled trials suggests that the Joel‐Cohen based techniques (Joel‐Cohen, Misgav‐Ladach) have short‐term advantages over Pfannenstiel (11 trials) and traditional lower midline (two trials) methods. Blood loss, operating time, time from skin incision to birth of the baby, use of pain killers, time to oral intake and bowel function or mobilisation and fever are all reduced.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

The incidence of hypotension during spinal anaesthesia for caesarean section is reduced by administering intravenous fluids, the drugs ephedrine or phenylephrine, or by leg compression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Corticosteroids for preventing respiratory complications in the newborn after caesarean section at term

Babies born at term (at or after 37 weeks) by planned (elective) caesarean section and before onset of labour are more likely to develop respiratory complications than babies born vaginally. The giving of injections called "corticosteroids" to the mother has been shown to reduce the risk of newborn babies having breathing problems in babies born before 34 weeks, but it is not clear if they are useful after this stage. The risk of respiratory complications, mostly respiratory distress syndrome and transient tachypnoea, decreases from 37 weeks to 39 weeks of gestation, at which stage it is low. The aim of this review was to investigate if corticosteroids can reduce the rates of respiratory problems and the need for admission into special care units when given before planned (not emergency) caesarean section at term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Abdominal surgical incisions for caesarean section

In a caesarean section operation, there are various types of incisions in the abdominal wall that can be used. These include vertical and transverse incisions, and there are variations in the specific ways the incisions can be undertaken. The review of studies identified four trials involving 666 women. The Joel‐Cohen incision showed better outcomes than the Pfannenstiel incision in terms of less fever for women, less postoperative pain, less blood loss, shorter duration of surgery and shorter hospital stay. However, the trials did not assess possible long‐term problems associated with different surgical techniques.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes

Women having a caesarean section under regional anaesthesia are often highly anxious during the operation and may feel some discomfort. Listening to relaxing music of the woman's choice may lead to better outcomes and less need for treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Comparing different types of antibiotics given routinely to women at caesarean section to prevent infections

Women undergoing caesarean section have an increased likelihood of infection compared with women who give birth vaginally. These infections can be in the urine, surgical incision, or the lining of the womb (endometritis). The infections can become serious, causing, for example, an abscess in the pelvis or infection in the blood, and very occasionally can lead to the mother's death. Sound surgical techniques are important for reducing infections, along with skin antiseptics and antibiotics. However, antibiotics can cause adverse effects such as nausea, vomiting, skin rash and rarely allergic reactions in the mother, and the risk of thrush (candida) for the mother and the baby. Antibiotics, given to women around the time of giving birth, can also change the baby's gut flora and thus may interfere with the baby's developing immune system.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Comparison of different positions that a mother is placed in during caesarean section to improve outcomes for both the mother and her newborn

Caesarean section is an operation that is performed on many pregnant woman to deliver the baby. During caesarean section the mother can be placed in a number of positions on the theatre table. Cushions and wedges can also be used to alter her position on the table and devices can also be used to displace the uterus laterally. This review aimed to assess the best position for the mother to be in during the surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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