title: [Post-partum management after cesarean delivery. Guidelines for clinical practice].
abstract: OBJECTIVE
  To determine guidelines for post-partum management after cesarean delivery regarding patient monitoring, organization, postoperative analgesia, time of urinary catheter removal, resumption of feeding and drinking, timing of ambulation, indication and modalities of thromboprophylaxis.
  
  
  METHODS
  The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
  
  
  RESULTS
  Immediate postoperative monitoring after caesarean delivery should be performed in the recovery room, but in exceptional circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (professional consensus). Specific surveillance including emergency call procedures must be performed (professional consensus). Systematic blood count performed immediately after cesarean delivery is not recommended in the general population (professional consensus). An analgesic protocol developed by the medical team should be available for each patient (professional consensus). An indwelling bladder catheter should be inserted before and maintained during surgery (professional consensus). The bladder catheter should be preferentially removed in the first 12 hours after cesarean delivery (professional consensus). It is recommended to check that spontaneous voiding has occurred in the 4-6 hours after the removal of the bladder catheter. The physician in charge should be alerted if the patient has failed to void within 6 hours after catheter removal (grade C). Early ambulation on day 1 (or earlier from the 6th to 8th hour) with help is advised and encouraged (professional consensus). Early feeding and drinking after elective or emergency cesarean delivery, performed under regional or general anesthesia, is recommended (grade A). Administration of a prophylactic treatment using two antiemetic medications is recommended during cesarean delivery (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). In obese patient, LMWH dose needs to be weight-adapted (grade C).
  
  
  CONCLUSIONS
  Harmonization of care according to these recommendations is expected to enhance recovery after cesarean delivery.
authors.affiliation: Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et santé des populations (CESP), U1018, reproduction et développement de l'enfant, 94807 Villejuif, France. Electronic address: florent.fuchs@bct.aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Fuchs
authors.affiliation: Service d'anesthésie réanimation, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; U1195 Inserm, université Paris-Sud « Petites molécules de neuroprotection, neurorégénération et remyélinisation », 94270 Le Kremlin-Bicêtre, France. Electronic address: dan.benhamou@bct.aphp.fr.
authors.forename: D
authors.initials: D
authors.lastname: Benhamou
mesh_terms: D016362:Analgesia, Obstetrical / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000009:adverse effects / Q000534:rehabilitation* / Q000706:statistics & numerical data; D002921:Cicatrix / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D049590:Postpartum Period / Q000502:physiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy
keywords: Antalgiques; Antiémétiques; Bladder catheter; Caesarean delivery; Césarienne; Early feeding; Enhanced recovery; Lever précoce; Post-partum; Postoperative analgesia; Réalimentation; Sonde vésicale; Thromboprophylaxie; Thromboprophylaxis