Scheduled Repeat Cesarean Delivery

Abstract

A healthy 30-year-old woman, G2P1, presents for a repeat cesarean delivery. Her weight is 78 kg, her height is 1.62 m, and her BMI is 29.7. She has no significant medical history and the indication for her previous cesarean delivery was cephalopelvic disproportion (L-1). The placenta is located in the uterine fundus with no ultrasound evidence of abnormal invasion of the uterus (L-2). Her obstetric course with this pregnancy was unremarkable and she is not in labor. The patient has been NPO after midnight—except for water, which was allowed in small quantities up until 2 hours before surgery (L-3). The patient receives sodium citrate 30 mL po and cefazolin 2 gm IV 15 minutes prior to the induction of anesthesia (L-4). A spinal anesthetic is administered through a 25 gauge needle at L3–4 (L-5) in the sitting position with 1.6 mL bupivacaine 0.75% (12 mg), 25 mcg of fentanyl, and 100 mcg of morphine (L-6). After the intrathecal injection, the patient lies back onto the OR table and is positioned with the uterus tilted to the left (L-7). After the spinal starts to take effect and until delivery, phenylephrine boluses in doses of 25–100 mcgm are used to maintain MAP above 80 mm Hg (roughly 100 systolic) (L-8).