The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist

Intraoperative Surgical Treatment of Undiagnosed Placenta Percreta

“…It is more accurate in diagnosing a posterior placenta, placenta percreta with or without placenta previa and for obese patients. MRI is more costly and accurate than ultrasonography in identifying adherent placenta [14]. Features of placenta percreta in non-enhanced MRI include loss of myometrium overlying the placenta, placental tissue extending to the bladder, heterogeneous signal intensity in the placenta, focal areas of uterine bulging, and loss of interface with adjacent organs [15].…”

General anesthesia for caesarean section

“…In an attempt to reduce the risk of maternal infection, worldwide guidelines including those of 'The National Institute for Health and Clinical Excellence' (NICE) in the UK recommend antibiotic administration before skin incision rather than after cord clamping [7]. Of note, this early administration of antibiotics is only superior for the prevention of endometritis, but not for the reduction of overall infectious morbidity [8].…”

“…(3) use of low-dose thiopental; (4) use of muscle relaxants; (5) difficult airway management; (6) obesity; (7) brief period between anaesthetic induction and start of surgery with only little time for supplementation of the intravenous (i.v.) induction dose with propofol or a volatile agent; and (8) high frequency of urgent surgery often performed out of working hours, resulting in higher rates of nonconsultant care.…”

Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial

“…The debate on the timing of antibiotic administration at cesarean has emerged in the last several years with the publication of several observational studies, 6,9,11 clinical trials, 5,7,8,10,[12][13][14]18 a review article, 19 and meta-analyses. 16,20 These results culminated in American College of Obstetricians Gynecologists issuing a Committee Opinion advocating that all women undergoing a cesarean delivery be given prophylactic antibiotics before skin incision, 17 and the National Institute for Health and Clinical Excellence advising clinicians to offer prophylactic antibiotics at cesarean before skin incision.…”