Fuchs F, Benhamou D
Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et santé des populations (CESP), U1018, reproduction et développement de l'enfant, 94807 Villejuif, France.
Service d'anesthésie réanimation, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; U1195 Inserm, université Paris-Sud « Petites molécules de neuroprotection, neurorégénération et remyélinisation », 94270 Le Kremlin-Bicêtre, France.
J Gynecol Obstet Biol Reprod (Paris). 2015 Dec;44(10):1111-7. doi: 10.1016/j.jgyn.2015.09.020. Epub 2015 Oct 31.
To determine guidelines for post-partum management after cesarean delivery regarding patient monitoring, organization, postoperative analgesia, time of urinary catheter removal, resumption of feeding and drinking, timing of ambulation, indication and modalities of thromboprophylaxis.
The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
Immediate postoperative monitoring after caesarean delivery should be performed in the recovery room, but in exceptional circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (professional consensus). Specific surveillance including emergency call procedures must be performed (professional consensus). Systematic blood count performed immediately after cesarean delivery is not recommended in the general population (professional consensus). An analgesic protocol developed by the medical team should be available for each patient (professional consensus). An indwelling bladder catheter should be inserted before and maintained during surgery (professional consensus). The bladder catheter should be preferentially removed in the first 12 hours after cesarean delivery (professional consensus). It is recommended to check that spontaneous voiding has occurred in the 4-6 hours after the removal of the bladder catheter. The physician in charge should be alerted if the patient has failed to void within 6 hours after catheter removal (grade C). Early ambulation on day 1 (or earlier from the 6th to 8th hour) with help is advised and encouraged (professional consensus). Early feeding and drinking after elective or emergency cesarean delivery, performed under regional or general anesthesia, is recommended (grade A). Administration of a prophylactic treatment using two antiemetic medications is recommended during cesarean delivery (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). In obese patient, LMWH dose needs to be weight-adapted (grade C).
Harmonization of care according to these recommendations is expected to enhance recovery after cesarean delivery.
确定剖宫产术后患者管理的指南，内容涉及患者监测、组织安排、术后镇痛、导尿管拔除时间、饮食恢复、下床活动时间、血栓预防的指征及方式。
查阅了PubMed数据库、Cochrane图书馆以及法国和国外产科协会或学会的建议。
剖宫产术后即刻监测应在恢复室进行，但在特殊情况下，若能维持安全规则并通知监管部门，也可在产房进行（专业共识）。必须进行包括紧急呼叫程序在内的特定监测（专业共识）。一般人群不建议剖宫产术后立即进行系统血常规检查（专业共识）。医疗团队应针对每位患者制定镇痛方案（专业共识）。手术前应插入并在手术期间留置膀胱导尿管（专业共识）。膀胱导尿管应优先在剖宫产术后12小时内拔除（专业共识）。建议在拔除膀胱导尿管后4 - 6小时检查患者是否已自主排尿。若患者在拔除导尿管后6小时内未排尿，应提醒主管医生（C级）。建议并鼓励在术后第1天（或更早从第6至8小时开始）在协助下尽早下床活动（专业共识）。建议在区域或全身麻醉下进行择期或急诊剖宫产后尽早进食和饮水（A级）。剖宫产期间建议使用两种止吐药物进行预防性治疗（B级）。对于每例剖宫产，建议在手术当天早晨应用弹力袜进行血栓预防，并至少在术后保留7天（专业共识），根据是否存在其他风险因素以及风险因素的类型（主要、次要）决定是否加用低分子肝素，肥胖患者的低分子肝素剂量需要根据体重调整（C级）。
按照这些建议统一护理有望促进剖宫产术后的恢复。
