II. Management: Acute

  1. Transfer to postpartum ward when stable
  2. Vital Signs q15 minutes for 1 hour, then q4 hours
  3. Monitor intakes and outputs every 4 hours for 24 hours
  4. Activity:
    1. Bed rest
    2. Supine for 8 hours after spinal anesthetic
    3. Incentive Spirometry every 1 hour while awake
  5. Standard Diet
    1. Nothing by mouth for 8 hours after cesarean section
    2. Sips of water after 8 hour window
    3. Advance to clear liquids as tolerated
    4. Advance to Regular diet when flatus or Bowel Movement
  6. Early Solid Diet Protocol
    1. Solid food within 8 hours of C-Section
    2. Well tolerated
    3. Resulted in faster bowel function return
    4. Shortened hospital stay by 24 hours
    5. Patolia (2001) Obstet Gynecol 98:113-6 [PubMed] (or open in [QxMD Read])
  7. Intravenous fluids
    1. D5LR OR D51/2NS at 125 cc/hour
    2. Foley to gravity
  8. Contact physician for
    1. Temperature > 100.4
    2. Systolic Blood Pressure <90 mmHg or >140 mmHg
    3. Diastolic Blood Pressure >90 mmHg or <50 mmHg
    4. Heart Rate >130 or <60
    5. Respiratory Rate >32 or <8
    6. Urine output
      1. Foley Catheter in place: <60 cc in 2 hours
      2. Intermittent Urine collection: <300 cc per shift

III. Medications:

  1. Antibiotics if patient labored before cesarean section
    1. Cefoxitin 2 grams IV every 4 hours for 3 doses or
    2. Ancef 1 gram IVPB every 8 hours for 3 doses
  2. Nausea
    1. Inapsine 1.25 mg IM/IV every 4-6 hours prn Nausea
  3. Initial Analgesia
    1. Demerol 50-75 mg IM every 3-4 hours prn
    2. Morphine 10 mg IM every 3-4 hours prn
    3. Vistaril 25-50 mg IM every 3-4 hours prn
  4. Later analgesia
    1. Ibuprofen 800 mg PO tid prn
    2. Tylenol #3 1-2 mg PO every 4-6 hours prn
  5. Other Medications
    1. Iron Sulfate dosing based on Postpartum Anemia
    2. Prenatal Vitamin po qd
    3. Colace 100 mg PO bid OR 200 mg PO at bedtime
    4. Mylicon 80 mg PO qid prn bloating
    5. Milk of Magnesia

IV. Labs

  1. Complete Blood Count in morning
  2. Maternal Blood Type Indications for Cord Blood
    1. Mother Rh Negative

V. Rounds

  1. Assess
    1. Abdominal and perineal Pain
    2. Lochia
    3. Flatus or Bowel Movement
  2. Examine
    1. Cardiopulmonary exam
    2. Abdominal examination
      1. Fundal height
      2. Uterine tenderness
      3. Bowel sounds
      4. Incision clean and dry
    3. Extremity exam
      1. Calf tenderness
      2. Homan's sign
  3. Intravenous Access discontinuation
    1. Patient taking adequate fluids
    2. No signs of Postpartum Hemorrhage
  4. Discontinue Foley Catheter when no longer needed
  5. Administer Rubella shot id mother not immune
    1. RubellaVaccine 0.5 cc SQ at Discharge
  6. Mother Rh Negative
    1. Blood Type and Indirect Coombs
    2. Cord blood sent to lab
    3. RhoGAM indicated for Rh Positive infant

VI. Disposition

  1. Staple Removal
    1. Horizontal incision
      1. Remove staples on Day 3-4 and place steri-strips
    2. Vertical incision
      1. Remove staples on Day 4-5
  2. Follow-up in clinic
    1. Status post Cesarean Section at 2 weeks
    2. Postpartum visit at 6 weeks

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