Cesarean section is an obstetric procedure in which the abdominal wall and uterine wall are cut open after 28 weeks of pregnancy to remove the fetus and its appendages (placenta, fetal membranes, umbilical cord). Rational optimization of caesarean section has become one of the priorities in the field of maternal and child health. On January 25, 2024, the National Center for Obstetric Professional Medical Quality Control and the Perinatal Medicine Branch of the Chinese Medical Association issued the Expert Consensus on Cesarean Section Surgery (2023), which finally formed 17 recommendations on clinical issues, mainly involving the near-term and long-term maternal and child impact of cesarean section, surgical medical indications, emergency cesarean section management, anesthesia methods and the use of antimicrobial drugs and other clinical and perioperative management plans.
Testimonials
1. Vaginal delivery is recommended when there is no medical indication for the pregnant woman and fetus (level of recommendation and evidence: 1B).
2. Cesarean section without medical indication is not recommended before 39 weeks of gestation (recommendation and level of evidence: 1B).
3. A triage approach is recommended for the management of emergency cesarean section (recommendation and level of evidence: 1C).
4. On the basis of adequate individualized assessment, determine the medical indications for cesarean section.
5. Neuraxial anesthesia is preferred for cesarean section, and general anesthesia can be selected in special cases (recommendation and level of evidence: 1B).
6. Drink clear liquid 2 h before surgery, and abstain from solid food 6~8 h before surgery. For women at high risk of aspiration, severe dietary restriction is recommended (level of recommendation and evidence: 1C).
7. Prophylactic antimicrobial use is recommended within 60 minutes before surgical skin incision, and prophylactic antimicrobial drugs are discontinued within 24 hours (level of recommendation and evidence: 1B).
8. Regarding the suture method of uterine incision after the first cesarean section, there is currently insufficient evidence to prove that the single-layer suture method is superior to the double-layer suture method, and the double-layer suture method is preferred (recommendation and level of evidence: 2C).
9. There is no clear evidence to support the superiority of suturing the rectus abdominis muscle during caesarean section over not suturing the rectus abdominis (recommendation and level of evidence: 2B).
10. Routine suturing of the peritoneum during caesarean section is controversial, and there is a current tendency to recommend peritoneal suturing (level of recommendation and evidence: 1C).
11. Multimodal analgesia should be used after cesarean section, and neuraxial opioids and regular administration of non-opioid analgesics are recommended (recommendation and level of evidence: 1B).
12. Epidural analgesic pumps are not recommended as a routine analgesic regimen (recommendation and level of evidence: 2C).
13. Accelerated recovery after cesarean section is recommended to promote rapid recovery after cesarean section (level of recommendation and evidence: 1C).
14. The interval between second pregnancies after cesarean section is recommended to be no less than 18 months (recommendation and level of evidence: 1C).
15. The Robson classification system is recommended for monitoring, assessing, and comparing caesarean section rates between institutions and regions (level of recommendation and evidence: 1B).
16. It is recommended that the indications for deciding on caesarean section be clearly documented (level of recommendation and evidence: 1B).
17. For pregnant women with a history of previous cesarean section, the choice of delivery mode for a second pregnancy should be individualized (recommendation and level of evidence: 1C).
Reference: National Center for Medical Quality Control in Obstetrics, Chinese Society of Perinatal Medicine, Chinese Medical Association.Expert consensus on cesarean section surgery (2023)[J]. Chinese Journal of Obstetrics and Gynecology,2024,59(01):14-21. DOI:10.3760/cma.j.cn112141-20231012-00144