Post Cesarean Section

In O.B.O.T.
Post operative orders are written
Entries in the respective OBOT record books are done.
Front page entry is made in the file.
Foot print of the baby is checked.
The baby has been shown to the relative and their signature is taken.
Foley's catheter is strapped to the patient's thigh.
Anesthetists have evaluated the patient before shifting to postoperative ward.
Servant is asked to shift patient to the post operative ward.
The patient's case papers are sent with the patient.
Post operative ward
The patient has been shifted to the bed.
Post operative orders are carried out.
The patient is asked to remain nil by mouth.
Vital parameters are checked regularly: temperature, pulse, blood pressure, urine output(volume, clear /concentrated/ hematuria)
Per abdominal examination is done
Uterus (well contracted or not)
Guarding, rigidity or tenderness
Dressing (dry or soaked)
Abdominal girth
Vulvar pad is checked for post partum hemorrhage.
Post operative monitoring:
half hourly for first 2 hours
hourly for next 4 hours
2 hourly up to 24 hours
Check for vital parameters, per abdomen and per vaginal bleeding.
Seniors are informed if:
pulse <60 or >100/min
blood pressure < 90/60 or > 140/90 mm Hg
urine output <60 ml/2 hours
abdominal girth > 3cm/hour
excessive vaginal bleeding
Post operative day 2
Vital parameters, per abdomen and per vaginal bleeding are checked.
Fluid input and output are checked.
Dressing is checked: dry or soaked.
Peristaltic sounds are checked.
Oral sips of water are given if peristalsis is present.
Tolerance of oral water is checked.
The patient is ambulated.
Foley’s catheter is removed.
It is noted if the patient passes urine subsequently.
Shift patient to PNC or PPS.
Post operative day 3
Soft diet is given. Full diet is given if soft diet is tolerated.
Dressing is checked: dry or soaked
Adequacy of lactation and proper breast feeding are confirmed. If not counseling is done and support is given.
Urine is sent for urinalysis and blood is sent for hemoglobin estimation according to unit protocol.
Required investigations are done and and references are made for associated co morbidities.
Post operative day 5
Wound is checked (healthy or not) as per unit protocol.
If healthy- patient is discharged and called on a later date for suture removal on respective days of the unit.
If unhealthy
wound swab is sent for microbiologic study.
Wound dressing is done every day.
Antibiotic is changed according to culture sensitivity report.
Secondary suturing is done when the wound is healthy.
The patient is then discharged, with appointment for suture removal.
On discharge
Contraceptive counseling is done
Breast feeding advice is given
Pament of all dues is confirmed, e.g. charges paid for 3rd child
JSY card is given.
OT notes are checked.
Collection of TL money by the patient is confirmed as applicable.
Discharge card is given before 12:00 noon.