AWHONN Response: What do nurses and other healthcare providers need to know to promote evidence-based care and optimal outcomes to pregnant women requiring surgery during pregnancy or birth by cesarean section?

AWHONN Response to Relevant Patient Groups:

Patient Population

Pregnant women needing surgery during pregnancy

Pregnant women delivering by cesarean birth

Postpartum women delivered by cesarean birth

Infants born by cesarean birth

Therapies may include but are not limited to prevention of complications associated with operative birth:

Prevention of maternal aspiration with medications (Non-particulate antacids, H2 receptors, or upper GI motility moderators)

Prevention of venous thromboembolism with medication or mechanical devices

Prevention of maternal skin infection with preoperative antibiotics, preoperative skin cleansing (providone iodine, chlorhexidine or other solutions) and post surgical incisional glues).

AWHONN Response for health related benefits:

Improving outcomes for women having cesarean birth.

Creating synergy between units by incorporating and applying operating room and post anesthesia standards and guidelines to the labor and delivery environment.

Providing evidence-based care during the preoperative, intraoperative and postoperative periods for women having scheduled and unscheduled cesarean birth.

Decreasing maternal and neonatal post cesarean birth complications

Providing resources for early recognition and intervention for maternal and neonatal complications associated with cesarean birth.

According to the preliminary birth statistics for 2015, the overall cesarean delivery rate declined to 32% from 32.2% (Hamilton, Martin & Ventura, 2016). However, almost 1/3 of all births remain surgical. Severe maternal morbidity is higher in women having cesarean birth when compared to vaginal birth (Curtin, Gregory, Korst & Uddin, 2015). Studies have shown that women having cesarean birth, specifically primary cesarean birth, have higher risks of post birth complications including hemorrhage, uterine rupture, anesthetic complications, shock, venous thromboembolism and infection (Liu et al., 2007; Curtin et al.). This guideline is a key resource for nurses and healthcare providers to identify and implement current evidence-based practices for all phases of cesarean birth (pre, intra, and postoperative care), and during care of post surgical complications.

AWHONN Response to informed decisions:

Information provided from a systematic review on perioperative care of pregnant women will help the revision team to identify high-risk areas that should be added to the current guideline, identify the most current evidence-based literature that will inform the revision process, and provide overall feedback on the current document (see attached guideline). The topics included are:

Patient safety measures for surgery for pregnant women

Non-obstetric surgery in pregnancy

Family-centered care during cesarean birth

Preoperative Education for cesarean birth

Current interventions for care in the preoperative phase, intraoperative phase, and postoperative phases

Considerations for unscheduled cesarean birth (transitioning from vaginal birth)

Maternal and neonatal postoperative complications after cesarean birth

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Catherine M. Hill FNP-BC Nurse Program Development Specialist at the Association of Women s Health, Obstetric, and Neonatal Nurses. I am currently the program manager and a science team member of the revision panel for the Evidence-Based Clinical Practice Guideline: Perioperative Care of the Pregnant Woman.

If you are you making a suggestion on behalf of an organization, please state the name of the organization

Association of Women s Health, Obstetric and Neonatal Nurses (AWHONN)

Please tell us how you heard about the Effective Health Care Program

In 2015, AHRQ contacted AWHONN directly to inquire about our interest in submitting a nomination for systematic review. At that time, we submitted a nomination for Assessment and Care of the Late Preterm Infant Evidence-Based Clinical Practice Guideline. AHRQ subsequently provided AWHONN with a preliminary report. We found the information provided to be useful for revision of this guideline, and therefore AWHONN believes that it will be beneficial to have a systematic review performed for all AWHONN Evidence-Based Clinical Practice Guidelines when feasible.