Quality statement 9: Monitoring for postoperative complications following caesarean section

Quality statement 9: Monitoring for postoperative complications following caesarean section

Quality statement

Women who have had a caesarean section are monitored for postoperative complications.

Rationale

Postoperative monitoring with regular observations in the immediate post-surgical period by someone with expertise in postoperative care is a key part of managing potential complications associated with surgery, including caesarean section. This needs to happen alongside the core postnatal care all women receive in hospital immediately after giving birth.

Quality measure

Structure: Evidence of local arrangements to ensure that women who have had a caesarean section are monitored for immediate postoperative complications.

Process: The proportion of women who have had a caesarean section who were monitored for immediate postoperative complications.

Numerator – the number of women in the denominator who are monitored for immediate postoperative complications.

Denominator – the number of women who have a caesarean section.

Outcomes: Rates of complications in women who have had a caesarean section.

What the quality statement means for each audience

Services providers ensure that systems are in place for women who have had a caesarean section to be monitored for postoperative complications.

Healthcare professionals ensure that women who have had a caesarean section are monitored for postoperative complications.

Commissioners ensure that they commission services in which women who have had a caesarean section are monitored for postoperative complications.

Women who have had a caesarean section are monitored for complications following the operation.

Source guidance

NICE clinical guideline 132 recommendations 1.6.1.1, 1.6.2.1 to 1.6.2.4, 1.7.1.3 and 1.7.1.6.

Data source

Structure: Local data collection.

Process: Local data collection.

Outcome: Local data collection.

Definitions

Monitoring complications

NICE clinical guideline 132 section 1.6.2 recommends the following in women who have had a caesarean section:

  • After caesarean section by general anaesthetic, women should be observed on a one-to-one basis by a properly trained member of staff until they have regained airway control and cardiorespiratory stability and are able to communicate.

  • After recovery from all forms of anaesthesia, observations (respiratory rate, heart rate, blood pressure, pain and sedation) should be continued every half hour for 2 hours, and hourly thereafter provided that the observations are stable or satisfactory. If these observations are not stable, more frequent observations and medical review are recommended.

The Centre for Maternal and Child Enquiries provided an example tool called the modified early obstetric warning score (MEOWS) to support monitoring after caesarean section.