Non-Elective Caesarean Section (including …€¦ · Web viewCorrect classification of...
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CHHS17/245 Canberra Hospital and Health Services Clinical Procedure Non-Elective Caesarean Section (including classification of urgency) Contents Contents..................................................... 1 Guideline Statement..........................................2 Scope........................................................ 3 Section 1 – Non-elective caesarean section classification....3 Section 2 – Non-elective caesarean section roles and responsibilities............................................. 4 Implementation............................................... 6 Related Policies, Procedures, Guidelines and Legislation.....6 References................................................... 7 Search Terms................................................. 7 Doc Number Version Issued Review Date Area Responsible Page CHHS17/245 1 25/10/2017 01/08/2022 WY&C - Maternity 1 of 10 Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
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CHHS17/245
Canberra Hospital and Health ServicesClinical Procedure Non-Elective Caesarean Section (including classification of urgency)Contents
Contents....................................................................................................................................1
Guideline Statement.................................................................................................................2
Scope........................................................................................................................................ 3
Section 1 – Non-elective caesarean section classification.........................................................3
Section 2 – Non-elective caesarean section roles and responsibilities.....................................4
Implementation........................................................................................................................ 6
Related Policies, Procedures, Guidelines and Legislation.........................................................6
References................................................................................................................................ 7
Search Terms............................................................................................................................ 7
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Guideline Statement
This Clinical Guideline provides clinical guidance for: Evidence based care for a woman undergoing a non-elective caesarean birth. A classification of non-elective Caesarean section according to clinical urgency Steps to be completed prior to an non-elective Caesarean section Guidelines for arranging for the presence of support person/s at a Caesarean section
BackgroundThe decision to proceed to a non elective caesarean should not be taken lightly and many factors should be taken into consideration.
These factors include the woman’s: past medical and surgical history past pregnancy and birth history current pregnancy complications current medications and allergies progress in labour and the fetal position
Other factors to take into considerations are the couples choices and wishes for this birth and plans for future pregnancies.
Fetal factors include the baby's position, gestation, wellbeing (Cardiotocography [CTG], fetal movements, ultrasounds, fetal heart rate [FHR] and scalp sampling results).
Organisational factors include the time of day, Birthing and Operating Theatre (OT) acuity, staffing levels and the acuity of the Neonatal Intensive care Unit (NICU).
In any given situation the degree of urgency should be based on objective evidence in relation to the condition of the newborn and the mother.
A known and trusted support person at a woman's birth enables her to feel safer and less anxious. Any birth (whether normal or operative) is a significant event in a family's life, and as such, a women's partner or nominated support person should always be considered as an active participant. Medical and midwifery staff play a crucial role in facilitating this.
Key objectivesCorrect classification of non-elective Caesarean section according to clinical urgency and to ensure Caesarean section is performed as per classifications and ‘target decision to delivery interval’ is met.
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Correct classification of non-elective caesareans enables clinically appropriate decision making and timely utilisation of resources.
Non elective caesarean sections can be a life threatening or emergency situation. Women and their partners must be given the opportunity to be involved in decision making where practicable. Women and their partners in this situation are vulnerable to feeling traumatised and anxious and must be given the opportunity to debrief after the birth.
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Scope
This document applies to the following Canberra Hospital Health Services (CHHS) staff working within their scope of practice: medical officers registered nurses and midwives student nurses and midwives working under supervision.
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Section 1 – Non-elective caesarean section classification
Evidence recommends that the four grade classification of urgency system for caesarean birth be used.
Each case should be managed according to the clinical evidence of urgency. A requested timeframe is to be communicated to theatre team leader and anaesthetist. Note that the target decision to delivery intervals are within suggested limits and a shorter target time may need to be communicated.
Grading of urgency to communicate to theatre.
Classification of Urgency. Clinical diagnoses included (not comprehensive).
Target decision to delivery interval
A Urgent threat to the life of a woman or baby.
Cord ProlapsePlacental AbruptionPlacenta praevia with active bleedingProlonged Bradycardia Scalp Lactate >5
delivery within 30 mins
B Maternal or fetal compromise but not immediately life threatening.
Abnormal CTG/Abandoned instrumental birthObstructed Labour
Delivery within 60 mins
C Needing earlier than planned delivery but without currently evident maternal or fetal compromise
Planned C/S, woman in labourBreech in labourNo progress
Delivery within 6 hours
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Grading of urgency to communicate to theatre.
Classification of Urgency. Clinical diagnoses included (not comprehensive).
Target decision to delivery interval
D Delivery timed to suit woman, theatre and Birthing staff
C/S indicated but not urgent
Verbally communicate the degree of urgency to all involved: midwifery staff, theatre staff, Neonatal team and the anaesthetist.
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Section 2 – Non-elective caesarean section roles and responsibilities
Registrar/Staff specialist: discuss the need for caesarean section with the woman and her partner obtain informed and written consent (or verbal if indicated as in an emergency) notify the obstetric consultant not already notified categorise and arrange the operation by ringing the Team Leader of OT notify the obstetric anaesthetist on call unless the OT Team Leader will do so notify the neonatal registrar of indication and timing of caesarean section if necessary as
per clinical guideline ‘Birth Requiring the Presence of a Neonatal Team Member’ documentation of the procedure must be compliant with legal and hospital
requirements and guidelines and be legible, clear, accurate and thorough. This is particularly pertinent if there is a complication with the surgery and for postnatal or future counselling around planning for subsequent pregnancies and births.
Midwifery Pre theatre:The midwife is to: reassure the woman and continue to provide labour care fast the woman from the time the decision is made ensure the woman's partner is aware of the situation and advise that only one support
person may accompany the woman to operating theatre for the caesarean section obtain appropriate theatre clothing for the woman's partner/ support person and advise
on theatre hat/ overshoes/ gown notify Birthing Unit Team Leader for assistance and to find a postnatal bed use emergency bed to transport women in category A & B and Post Natal Ward (PNW)
bed for women in category C & D ensure intravenous access and collect blood for:
o a full blood count and o cross match or o group and hold
ensure the woman’s details are correct on the identification bands and apply one to the woman’s wrist and one to her ankle
Prepare woman for theatre as per pre-op checklist including a set of observations.
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notify the Neonatal Registrar to attend the birth if indicated and the Special Care Nursery (SCN) or NICU team leader, again if clinically indicated as per clinical guideline ‘Birth Requiring the Presence of a Neonatal Team Member’
Position woman in left lateral position if appropriate or at a 15-degree lateral tilt if time allows ensure the woman is dressed in a hospital gown measure and apply TED stockings ensure all the woman's notes including CTG's, baby transport/ resuscitation cot/ sterile
receiving wrap, warm baby blankets, placenta bucket, cord blood and cord gas collection equipment, medication administration for Vitamin K, sterile scissors and Cord clamp are available
change into theatre clothes.
Midwifery in Theatre & Post Anaesthetic Care Unit (PACU)The midwife is to: maintain the fetal heart rate surveillance with transport CTG until skin is prepped for
surgery ensure all equipment for neonatal resuscitation is ready for use check sterile gown and gloves are opened ready provide the placenta bucket and cord blood collection pack to the scout nurse set up for Vitamin K administration, identification bands and cord gas collection prepare scrubs, gowns, gloves and sterile receiving wrap observe Australian College of Operating Room Nurses (ACORN) standards for staff
within 30 cm of sterile field resuscitate baby as per Neonatal Advanced Life Support (NALS) Algorithm collect cord gases if required, label appropriately and arrange delivery to pathology be responsible for the baby whilst in theatre and PACU facilitate skin to skin and early breastfeeding for the woman and baby transport baby resus cot, paperwork and placenta from theatre. accompany the family to PACU and facilitate breastfeeding complete baby cares, assessments and documentation Accompany the family back to the ward and hand over care of the baby. complete documentation debrief with the woman and family as appropriate.
Support Person: Will be dressed in scrubs with a red theatre hat and overshoes and white gown (which is
removed on arrival to theatre) accompany the women to holding bay on transfer to OT will be asked to remain in the holding bay whilst anaesthetic is
administered or topped up for spinal or epidural is encouraged to be seated at the women's head for support during the operation and is
to be made aware of sterile fields, however is permitted to take photographs if desired/ appropriate during the birth
is encouraged to trim the baby's cord and take photos and support the mother and baby during skin to skin in theatre and PACU.
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Note: If a general anaesthetic is used or decided on mid operation, the partner is to wait in holding bay. After the birth the midwife is to take the partner and the baby from theatre to the allocated postnatal bed to await mother. In this time the partner will be encouraged to have skin to skin with their baby and baby cares can be done. If expressed breast milk is available, this can also be given at this time until mother returns to PACU or the ward and is awake and well enough to commence breastfeeding.
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Implementation
Education will be provided to medical and midwifery staff on this clinical procedure and its relevance to practice.
The Clinical Procedure will be accessible via the Policy and Clinical Guidance Register.
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Related Policies, Procedures, Guidelines and Legislation
Policies Health Directorate Nursing and Midwifery Continuing Competence Policy Consent and Treatment Policy
Procedures CHHS Healthcare Associated Infections Clinical Procedure CHHS Patient Identification and Procedure Matching Procedure
Guidelines CHHS Fasting Guidelines – Elective and Emergency Surgery Fetal Surveillance Practice Guideline Labour 1st 2nd and 3rd stage care Birth Requiring the Presence of a Neonatal Team Member
Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Work Health and Safety Act 2011
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References
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1. ACORN, 2006. The Australian College of Operating Room Nurses Standards S24 “Support people in operating room”.
2. National Collaborating Centre for Women's and Children's Health. Caesarean section. In: National Institute for Clinical Excellence, London; 2004.
3. RANZCOG. Decision to delivery interval for Caesarean section. College Statement. Jul 2009;C-Obs 14
4. Categorisation of Urgency for caesarean section, July 2015 https://www.ranzcog.edu.au/RANZCOG_SITE
5. NICE Guideline Caesarean Section, June 2013RANZhttps://www.nice.org.uk/guidance/qs32
6. Women’s Healthcare Australasia: https://women.wcha.asn.au/news/association-between-rates-caesarean-section-and-maternal-and-neonatal-mortality-21st-century
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Search Terms
LSCS, LUSCS Lower uterine, Caesarean section, Classification, Non-elective, operative birth, Support people
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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.
Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair
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