1. OSCE: Post LSCS Management
24 years old Malay lady, G1P0 at 38 week of amenorrhea has been decided for elective lower
segment caesarean section operation in view of oblique lie. As a houseman, outline your
management to this lady post operatively.
Answer
1) Transfer the patient to the post natal wards after patient stable post-operatively.
2) Close monitoring of vital sign; temperature, oxygen saturation and blood pressure. To
inform the MO in charge if BP is high.
3) Keep patient in supine position for at least 4-6 hours.
4) Keep patient nil by mouth for 4-6 hours. If patient fully conscious, no headache and
vomiting, then may allow with clear fluid first then followed by solid food.
5) Continue IV pitocin 40 unit in 500 cc normal saline.
6) Strict input/output chart. Aim for urine output 0.5 ml/kg/hour. Off CBD after 24 hours.
7) Put patient on fluid maintenance (3 pints of normal saline and 2 pints of dextrose 5%
within 24 hours)
8) Look for any sign of complication
- Intra abdominal bleeding
- Aspiration pneumonia or respiratory distress.
- Post partum hemorrhage
- Hypovolumia
- Other type of infection
- Deep vein thrombosis
9) IV ampicillin 500 mg 6 hourly for three doses.
10) Adequate analgesia (eg; suppositories voltaren 50 mg t.d.s) if severe pain, may consider
opiod based analgesic with anti emetic. (IM Pethidine or IV morphine with IV maxalon)
11) Stokinett and encourage early ambulation to prevent DVT. Consider heparin infusion in
patient who is high risk to develop DVT.
12) Daily FBC (Hb and TWC level) and coagulation profile.
13) Wound inspection at day three. If no complication and wound healing well, then can
discharge the patient.
14) Encourage breast feeding once patient fully conscious.
15) Advise on contraception. Patient should not be pregnant for at least 2 years. Patient
should also be council regarding mode of delivery for the next pregnancy.