Precautions for Second Stage Arrest Cesarean Section

Maternal Positioning and Preparation

Position the parturient with left uterine displacement to avoid aortocaval compression, which is essential for maintaining maternal hemodynamics and fetal perfusion 1
Administer intravenous antibiotics within 60 minutes before skin incision; for women in labor or with ruptured membranes, add azithromycin to the first-generation cephalosporin for additional reduction in postoperative infections 2
Use chlorhexidine-alcohol for abdominal skin preparation and consider povidone-iodine solution for vaginal preparation to reduce post-cesarean infections 2
Implement measures to prevent hypothermia, including forced air warming, intravenous fluid warming, and increased operating room temperature 2

Regional anesthesia is preferred over general anesthesia as part of an enhanced recovery protocol 2
Be prepared for a potentially difficult airway, as this is common in pregnancy; have the most experienced provider available for airway management 3
Maintain euvolemia with crystalloid fluids (20 ml/kg, repeated as needed) for optimal maternal and neonatal outcomes 2, 4

Consider blunt expansion of the uterine hysterotomy to reduce surgical blood loss 2
Close the hysterotomy in 2 layers to potentially reduce the risk of future uterine rupture 2
Reapproximate subcutaneous tissue if ≥2 cm thick 2
Use subcuticular suture for skin closure to reduce wound separation 2

If maternal cardiac arrest occurs, immediately activate the emergency cesarean section team 5
Consider emergency cesarean section within 4 minutes of maternal cardiac arrest if there is no return of spontaneous circulation 5
Team planning should be done in collaboration with obstetric, neonatal, emergency, anesthesiology, intensive care, and cardiac arrest services 3, 5