Acknowledgments

i

Evidence-Based Clinical Practice Guideline Development

1

Evolution of AWHONN Evidence-Based Guideline Development

1

Literature Evaluation and Scoring

1

Quality-of-Evidence Rating

1

Evidence-Based Clinical Practice Guideline Elements

2

Evidence-Based Clinical Practice Guideline

3

Purpose Statement

3

Patient Population

3

Settings

3

Providers

3

Definition of Terms

4

Trends in Cesarean Birth

6

Rising Cesarean Birth Rates

6

Maternal Morbidity and Mortality

6

Cesarean Delivery on Maternal Request

7

Vaginal Birth after Cesarean Delivery/Trial of Labor after Cesarean

7

Complications Associated with Repeat Surgical Birth..;

8

Overview of the AORN Perioperative Standards

8

Terminology

10

Evidence-Based Clinical Practice Guideline

11

Patient Safety and Quality Improvement

11

Patient Safety

11

Quality Improvement

12

Nonobstetric Surgery in Pregnancy

14

Preoperative Education for Surgical Birth

18

Anesthesia Education

19

Nothing by Mouth, or NPO, Status Education

20

Skin Preparation

21

Preoperative Care

22

Maternal Satisfaction

22

Antibiotic Prophylaxis

24

Group B Streptococcus and Newborn Prophylaxis

26

Venous Thromboembolism Prophylaxis (Pre- and Postoperative)

26

Aspiration Prophylaxis

30

Prewarming Measures

31

Intraoperative Care

33

Regional Anesthesia for Surgical Birth

33

General Anesthesia for Cesarean Birth

37

Intraoperative Maternal Positioning

38

Urinary Catheters (Intraoperative and Immediate Postoperative Bladder Care)

39

Preoperative and Intraoperative Fetal Monitoring

41

Skin Antisepsis

42

Newborn Equipment and Care (Delivery Room Setup and Personnel)

45

Postoperative Care

47

Postoperative Equipment and Staffing

47

Immediate Postanesthesia Care and Postpartum Assessment

49

Pruritus

51

Postoperative Pain Management

52

Nausea and Vomiting

55

Postoperative Nutrition

56

Considerations for Unscheduled Surgical Birth

57

Psychosocial Considerations

57

Transition from Vaginal to Surgical Birth

58

Considerations for Decision-to-incision

60

Considerations for Multiple Births

61

Considerations for the Obese Patient

62

Postoperative Complications

65

Recognizing Deteriorating Conditions in the Postpartum Period

65

Pulmonary Embolus

66

Postpartum Hemorrhage

68

Surgical Site Infections and Endometritis

71

References

75

Appendix A

The Universal Protocol

90

Appendix B

World Health Organization, Surgical Safety Checklist

91

Appendix C

Guidelines for Submitting Continuing Nursing Education Application

92

Appendix D

CNE Application

93

Appendix E

Participant Feedback Form

94

Appendix F

Posttest

95