Hence, it has been recommended that the decision-to-delivery interval should be within 30 mins. Timing of caesarean section according to urgency. Is a C-section safe? Edited by prominent obstetricians in KK Women's and Children's Hospital, the largest maternity hospital in Singapore with about 12,000 babies delivered each year, this book provides a comprehensive and informative look at pregnancy and ... However, clinical application remains inconsistent. 3) Cohen JA, Holle DM, Meyers-Wallen VN. Consequently there is a need for veterinarians to be familiar… Category 4 The fully elective procedure. J Reprod Fertil Suppl 1993;47:174-80. Fig 2. 8) Luvoni GC and Beccaglia M. The Prediction of Parturition Date in Canine Pregnancy. . About 1 to 2 days longer on average. Am J Vet Res 1983;44:1819-21. Hence, it has been recommended that the decision-to-delivery interval should be within 30 mins. Theriogenology 1990;34:655-665. Purpose Cesarean sections, also called c-sections, are performed whenever abnormal conditions complicate labor and vaginal delivery, threatening the life or health of the mother or the . Introduction • Traditional classification ELECTIVE of C-section EMERGENCY (limited value for data collection and audit of outcomes) • In 2000, Lucas et al proposed a new classification, consisting of 4 categories, with a target DDI (Decision to delivery interval) for caesarean section for 'fetal compromise' of 30 minutes. 1 The incidence of cesarean deliveries, both repeat and primary, has risen dramatically over the last few decades, with an estimated global number of 22.9 million cesarean deliveries in 2012. 1 INTRODUCTION. Category-1 emergency caesarean section delivery is the commonly performed surgical procedure in pregnant women associated with significant . How a Caesarean Section Is Done Surgery preparation. Found insideThis can be overcome by using the term scheduled caesarean section for procedures that are planned ahead of time. ... Table 13.5 Classification system for emergency caesarean section Category 1: Immediate threat to life of woman or ... 2018 Jan;61(1):48-55. doi: 10.5468/ogs.2018.61.1.48. Many previous studies have failed to show any improved outcome with short decision-to-delivery interval. Patient Safety in Surgery, covers all aspects related to patient safety in surgery, including pertinent issues of interest to surgeons, medical trainees (students, residents, and fellows), nurses, anaesthesiologists, patients, patient ... About 20 more women per 100,000 who had caesarean birth would be expected to have this outcome; so the method of birth would have made no difference to the chance of the outcome for about 99,980 women per 100,000. • Intervention - Emergency or urg ent caesarean section (Category 1 and 2 in the NICE Guidelines (NICE, 2004) were also used 1); emergency birth; • Comparison/Control Intervention - The timing or decision to incision time frame • Outcomes or effects - neonatal outcomes (Apgar scores, admission to neonatal nurseries, We describe the trends and variation across 63 English NHS trusts in the timing of elective caesarean section (CS) for low-risk singleton . Decision-to-delivery interval: Is 30 min the magic time? Epub 2017 Apr 25. Category 3 The semi-elective procedure takes place when labour isn't progressing, and there's time for discussion. 32. Timing of caesarean section according to urgency. 2) Concannon PW, Whaley S, Leid D, Wissler R. Canine Gestation length: vacioation related to time of mating and fertile life of sperm. Parturition may occur anywhere from 57 to 72 days after a single observed breeding [2]. The guideline will: Support staff involved in the classification, timing and reason for all Caesarean Sections (CS) undertaken. Often, the only information provided is the breeding-dates and occasionally even those are hard to come by. Performance improvement addressed surgeon, anesthesiologist, operating room availability, nursing availability, and patient-related delays. The rates of caesarean delivery were 31% (222/707) in the public sector and 72% (302/419) in the private sector. There is also an increased risk of some complications and infections. Kinsella SM, Girgirah K, Scrutton MJ. Theriogenology 2008;70:397-402. Epub 2019 Jul 17. BMC Pregnancy Childbirth. Linking the caste systems of America, India, and Nazi Germany, Wilkerson explores eight pillars that underlie caste systems across civilizations, including divine will, bloodlines, stigma, and more. No association was observed between ALL and caesarean delivery either during or before labour, with adjusted ORs of 1.08 (95% CI 0.78, 1.48) and 1.09 (95% CI 0.78, 1.53), respectively. Bitches reliably whelp 64-66 days post LH surge [2,3], which can be diagnosed by repeated LH assay (every 12 hours due to the short duration of the LH surge in the bitch). Incidence and breed predilection for dystocia and risk factors for cesarean section in a Swedish population of insured dogs. Latest studies indeed have shown that bradycardia-to-delivery interval correlated significantly with arterial pH and base excess in life-threatening fetal conditions. Accuracy of canine parturition date prediction from LH peak. Anterior wall of uterus.JPG. Media in category "Caesarean section" The following 60 files are in this category, out of 60 total. Fetal distress: 150 beats/min – values of 150 or below indicate the urgent need for emergency intervention to save the puppy. 4 Crash cesarean section simulation drills and standardization of procedures for a crash cesarean section . An emergency caesarean section may be necessary to resolve dystocia, which may increase surgical and anaesthetic risks and possibly result in puppy loss You decide to explore whether the evidence supports the use of elective caesarean sections, particularly in situations or breeds with predispositions to dystocia, to maximise the survival of . More specific information is also available describing the appearance of specific structures in relation to whelping. Anesthesia for cesarean delivery in patients with preeclampsia and neuraxial labor analgesia are reviewed . Shortly after this period, vaginal cytology may be used to diagnose the onset of diestrus, occurring approximately 51-60 days before whelping [4]. Emergency cesarean delivery for nonreassuring fetal heart rate tracings. Fetal length exceeds chorionic width at approximately day 42. Timing of caesarean section according to urgency. PMC Maternal or fetal compromise, which is not immediately life threatening. This publication explains how you can recover the cost of business or income-producing property through deductions for depreciation (for example, the special depreciation allowance and deductions under the Modified Accelerated Cost Recovery ... Theriogenology 2008;70:291-199. The reasons are (1) most of these studies were of small scale and retrospective with limitation in design; (2) the indications for caesarean deliveries recruited in these studies were not specific for life-threatening fetal distress; (3) selection bias as clinicians tended to deliver worse cases more quickly than less severe cases; (4) correlation was analysed between adverse fetal outcome and decision to delivery interval, but ignored the bradycardia-to-delivery interval, which reflected the actual duration of fetal hypoxia. This topic will discuss the management of regional and general anesthesia for cesarean delivery. Often, the only information provided is the breeding-dates and occasionally even those are hard to come by. The first cesarean documented occurred in 1020 AD, and since then, the procedure has evolved tremendously. Association between preovulatory LH surge and the early ultrasonographic detection of pregnancy and fetal hearteats in beagle dogs. ISBN number: 978-1-74243-249-6 Endorsed by: [2004, amended 2021] 1.4.7 Do not routinely carry out the following tests before caesarean birth: cross-matching of blood. Category 4: At a time acceptable to both the woman and the caesarean section team, understanding that this can be affected by a number of factors. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of . Change ), You are commenting using your Twitter account. Fig 1. A cesarean section. On the contrary, the easiest and most accurate way to predict whelping is to diagnose or estimate the time of LH surge. Obstet Gynecol 2013; 121:561. Found inside – Page 206There are two main types of caesarean section, namely, the more common and preferred lower uterine segment operation (Fig. ... caesarean sections have been classified into four categories based on time limits within which the operation ... Delivery After Prior Cesarean is examined in the issue of Clinics in Perinatology, guest edited Drs. Mark Landon and Caroline Signore. Three basic methods exist to predict parturition in the bitch: While the easiest methods for timing involve breeding management, breeding dates provided by owners are notoriously unreliable. Objective To investigate whether antibiotic exposure during pregnancy was associated with childhood asthma and if this relationship was conditional on timing of exposure and mode of delivery. This guidance has been updated and replaced by NICE guideline NG192 and the recommendations on multiple pregnancy have been updated and replaced by NICE guideline NG137. 7) Lopate C. Estimation of gestational age and assessment of canine fetal marutation using radiology and ultrasonography: A review. Reduce doses of anaesthetic related drugs by 25-40%. Pregnancy can first be reliably diagnosed radiographically day 45-48 post LH surge. Most caesarean sections are done with epidural or spinal anesthesia, used to numb sensation in the abdominal area.Only in an emergency situation or when an epidural or spinal anesthesia cannot be used or is a problem would fast-acting general anesthesia be used to make you unconscious for a caesarean birth. Consequently, the goal of gestational timing should be to predict whelping accurately enough to intervene after final maturation has occurred but before the bitch is in active labor. Epub 2012 Oct 30. Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. Clipboard, Search History, and several other advanced features are temporarily unavailable. We proposed that modification of the wording of these definitions might improve consistency of assignment of urgency. This is most effective when you can get progesterone results back the same day the sample is drawn and sent to the lab. A caesarean section leaves a scar in the wall of the uterus which is considered weaker than the normal uterine wall. Who should use this tool: Nurses, physicians, midwives, and other labor and delivery (L&D) unit staff responsible for intrapartum care. In Burkina Faso, facility-based caesarean delivery rates have markedly increased since the national subsidy policy for deliveries and emergency obstetric care was implemented in 2006. c-section. Caesarean section, also known as C-section, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mother at risk. 1 This definition considers only the location of the fetus and not whether the fetus is delivered alive or dead. In England, rates of caesarean section have increased from 9% of births in 1980 to 24.8% in 2010. Introduction. This is particularly important when an elective caesarean section is desirable. Appl Clin Inform. Steps to be completed prior to an non-elective Caesarean section. Grade of urgency for Caesarean section Category 1. Am J Vet Res 1974;35:401-6, 5) Aissi A and Slimani C. Ultrasonographic appearance of the gestational structures throughout pregnancy in bitches. There are four different emergency caesarean section categories to assist with the prioritisation of theatre cases and utilisation of theatre according to clinical urgency for delivery . Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. Throughout this book, radically new situations are analysed, before appropriate questions are phrased.At a time when people commonly debate on the long-term effects of human activities without considering the probable transformations of ... 2005;44 Suppl 3:24-7. "A history of racist and antiracist ideas in America, from their roots in Europe until today, adapted from the National Book Award winner Stamped from the Beginning"-- A classification of non-elective Caesarean section according to clinical urgency . Limbuds, fetal movement and a fluid filled stomach may be seen on day 29, 30 and 33. Endorsed by the United Nations Secretary-General, this is a comprehensive WHO guideline on routine antenatal care for pregnant women and adolescent girls. This document establishes general principles of PPH care and it is intended to inform the development of clinical protocols and health policies related to PPH. What is the evidence? We conducted a cluster-randomized controlled trial of a multifaceted intervention at 22 referral hospitals in Burkina Faso. Cesarean section is a fetal delivery through an open abdominal incision (laparotomy) and an incision in the uterus (hysterotomy). Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others . Copyright © 2012 Elsevier Ltd. All rights reserved. C-sec suture.jpg. 1) and 2006 (n=574) cesarean deliveries were prospectively tracked for decision-to-incision time. The recovery from a C-section is longer than vaginal birth, so you can expect to stay in the hospital for a longer time. Longer hospital stay. The optimal timing of these deliveries needs to be determined with recent recommendations to delay births by elective CS until 39 weeks. Guidance. Worldwide, many obstetrical units are unable to routinely achieve a 30-minute decision-to-incision interval. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. Prior to these final maturation processes, puppy survival may be decreased due to weakness, poor mobility and respiratory distress after removal from the uterus. THE ESSENTIAL WORK IN TRAVEL MEDICINE -- NOW COMPLETELY UPDATED FOR 2018 As unprecedented numbers of travelers cross international borders each day, the need for up-to-date, practical information about the health challenges posed by travel ... The statements on the list in purple lettering are the essential checks and are noted on the top of the Pre-Induction and Pre-Incision list. 1. Does it work? Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Immediate threat to the life of the woman or fetus. Consequently there is a need for veterinarians to be familiar different with methods of estimating gestational age. 2009;68(4):248-54. doi: 10.1159/000239783. Everything you need to know to prepare you, your bitch, and your household for the upcoming C-section. You can estimate a bitch will be due to whelp 63 days after the . Even though there was no association of DDI with likelihood of having perinatal death, timing related factors that increased the likelihood of having at least one perinatal death at caesarean section were: cases where total anaesthesia time was longer than 2 h; time from induction to start of surgery was longer than 45 min and surgical time . Bethesda, MD 20894, Help ( Log Out / A number of factors play critical roles in the ultimate success-rate of elective c-sections, including fetal maturity, patient preparation, selection of anesthesia protocol and surgical technique as well as neonatal care of the pups. Kinsella SM, Carvalho B, Dyer RA, et al. Is a C-section safe? Caesarean section: summary of updated NICE guidance. Identification of factors influencing the decision-to-delivery interval in emergency caesarean sections. Methods We identified elective CS deliveries between 1 st April 2000 and 28 th February 2009 in English NHS trusts using the Hospital Episode Statistics. 2002 May;109(5):498-504. doi: 10.1111/j.1471-0528.2002.01323.x. C. Scott Bailey, DVM, MS, DACT Consultant, Veterinary Answers Veterinarians are often asked to perform pregnancy diagnosis and time a c-section with very little information from the owner. In Canada, nearly one in four births is by caesarian section. In Canada, nearly one in four births is by caesarian section. MeSH The dose requirements in pregnant patients can be considerably lower than in non-pregnant animals, therefore reduce the dose accordingly (see Caesarean Section Survival Guide. Fetal distress is an emergency condition requiring rapid caesarean delivery. A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Scheduling The C-Section . With a practical, accessible focus, aided by full colour illustrations, this book follows the journey that the patient makes through their surgical care, with sections on: The foundation for safe and effective perioperative care Infection ... Anesthesia and the Fetus integrates into one volume the multidisciplinary components of: fetal development fetal pharmacology assessments of fetal and neonatal outcome anesthesia and analgesia during pregnancy anesthesia and analgesia ... to a cesarean section. Training in teamwork and communication, availability of anaesthetists, and operation theatre are the main factors to achieve a quick caesarean delivery. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. This site needs JavaScript to work properly. Degu Ayele A, Getnet Kassa B, Nibret Mihretie G, Yenealem Beyene F. Int J Womens Health. Evidence based care for a woman undergoing a non-elective caesarean birth. BJOG. The accepted standard is within 30 minutes. Clinical decision -making about the timing of a planned caesarean section at term should follow a discussion with the woman and her family about the risks and benefits of all options for birth, and include information about the risks and benefits of birth after 39 +0. 2019 Oct;10(5):879-887. doi: 10.1055/s-0039-1700868. Wilmink FA, Hukkelhoven CW, Lunshof S, et al. weeks. Am J Anim Vet Sciences 2008;3(1):32-35. Fetal distress is an emergency condition requiring rapid caesarean delivery. •A simplified version is used for an Emergency C-Section. The c-section categories. 2. Read About Us in Veterinary Practice News. Pert. caesarean section. Book description to come. Tita AT, Lai Y, Landon MB, et al. Parturition and lactation in the bitch: serum progesterone, cortisol and prolactin. On the contrary, if these processes have occurred and the bitch experiences a dystocia, survival may also be decreased. Progesterone measures below 2ng/ml indicate imminent parturition within 18-36 hours. Feinberg J, Shaw S, Kashyap N, Illuzzi J, Campbell K, Hsiao AL, Pettker CM. Information collected included indication, urgency, and reason for delay. Effective and safe strategies are needed to prevent unnecessary caesarean deliveries. Objective To compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery. The pelvis and 13 pairs of ribs are visible 11 days (9-13) prepartum. Many previous studies have failed to show any improved outcome with short decision-to-delivery interval. Cesarean is the most common spelling variant in the U.S. C-section is a common procedure, but every surgery has its risks. Chauleur C, Collet F, Furtos C, Nourrissat A, Seffert P, Chauvin F. Gynecol Obstet Invest. 2020 Mar 17;20(1):164. doi: 10.1186/s12884-020-2828-z. The United Kingdom recognizes four categories of urgency for C-sections, a continuum of risk that dictates how long doctors can wait between deciding a C-section is necessary and actually . Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, and problems with . 12 A major reason for this increase is the decline in the rate of attempted vaginal birth after . • Intervention - emergency or urgent caesarean section (Category 1 and 2 in the NICE Guidelines (NICE 2004) were also used1); emergency birth • Comparison/Control Intervention - the timing or decision to incision time frame • Outcomes or effects - neonatal outcomes (Apgar scores; admission to neonatal Accessibility Four out of five units included caesarean section categories II and III. Would you like email updates of new search results? Decision-to-delivery interval in emergency cesarean delivery in tertiary care hospital in Thailand. Title: Microsoft Word - Categorisation of urgency for caesarean section (C-Obs 14) Author: cschmid Created Date: 8/7/2019 9:55:49 AM Progesterone timing at the end of pregnancy. Whether you're already familiar with rubrics or not, this book is a complete resource for writing rubrics that assist with learning as well as assess it. Parturition and lactation in the bitch: serum progesterone, cortisol and prolactin. Epub 2019 Nov 20. Epub 2017 Dec 15. Found inside – Page 68TABLE 5.2 Caesarean section categories Category Time of delivery 1 Immediate threat to the life of the woman and fetus; delivery should take place as soon as possible after decision has been made (within 30 minutes). Clinical guideline [CG132] Published: 23 November 2011. Cesarean section rates in the USA were 32.0% in 2015. Category 2. Temesgen MM, Gebregzi AH, Kasahun HG, Ahmed SA, Woldegerima YB. Evaluating the Impact of a New Smartphone Texting Tool on Patient Care in Obstetrics, an Emergent Healthcare Setting. Caesarean section rates have been steadily increasing due to a higher number of sections for fetal distress, as diagnosed by cardiotocographic (CTG) monitoring in labour, and their increasing use for breech and multiple pregnancy.However, the greatest contribution to the current high caesarean rates comes from elective repeat caesarean section (ERCS). The new 8th Edition provides a single place to look for the most recent and most trustworthy recommendations on quality care of pregnant women, their fetuses, and their neonates. 1 Successful vaginal birth after cesarean section (VBAC) was 70.4% for the former and 51.4% in the latter. Sorry, your blog cannot share posts by email. Diagnosis/definition: Classical cesarean is a midline uterine incision in the contractile portion of the . In this review we focus on only the first of these – Timing of c-section to maximize fetal maturity. Recent reports by the Consortium on Safe Labor, including 19 hospitals, show that the rate of cesarean birth among nulliparous women has risen to more than 30 percent. Design and setting and main outcome measures Retrospective study of term singleton pregnancies delivering at a major tertiary unit in Brisbane, Australia. South Australian standards have been developed for the management of Category One caesarean section. We also summarised the indications for caesarean sections in the included . Over recent decades, cesarean delivery has become more commonly used, and this increase has generated a number of controversial issues . Cesarean delivery rates in the United States are at the highest levels ever, with more than 1.3 million cesarean deliveries (32% of all births) performed in 2015 1. Elective c-sections can carry an excellent prognosis for maternal and fetal viability when timed correctly and may be less stressful to the bitch, puppies and attending veterinarian than waiting for a potential dystocia. Disclaimer, National Library of Medicine By continuing you agree to the use of cookies. We describe the trends and variation across 63 English NHS trusts in the timing of elective caesarean section (CS) for low-risk singleton deliveries. Many previous studies have failed to show any improved outcome with short decision-to-delivery interval. The switchboard will activate the Group Crash Call for caesarean section. The scapula, humerus and femur are first detectable 17 days (15-18) prepartum. There is virtually no risk of uterine rupture in women undergoing ERCS (i.e. 31. Δdocument.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Post was not sent - check your email addresses! Found inside – Page 34Category 4 At a time to suit the woman and maternity team The suggested standard for a category 1 caesarean section is delivery within 30 minutes of the time of decision. It is debatable whether there is evidence linking this time ... Health at a Glance 2017 presents the latest comparable data and trends on key indicators of health outcomes and health systems across the 35 OECD member countries. Healthcare professionals have to provide evidence based information for women about the risks and benefits of both planned and unplanned caesarean section. It’s why we’re here.” Whether you’ve read Daring Greatly and Rising Strong or you’re new to Brené Brown’s work, this book is for anyone who wants to step up and into brave leadership. Category 1 caesarean section will aim to deliver as soon as is safely possible from the time of decision but not longer than 30mins. Found inside – Page 274timing. and. classification. the purpose of classifying the urgency of CSs is to balance the safe management of the mother ... Classification of urgency of caesarean section Grade Definition (at time of decision to operate) Category 1 ... 8600 Rockville Pike Prevention and treatment information (HHS). A temperature drop by 1-3F from previous measures occurs in 75-85% of bitches within 8-18 hours prior to parturition. 2019 Dec;69(6):509-513. doi: 10.1007/s13224-019-01250-2. Association Between Fetal Middle Cerebral Artery and Umbilical Artery Doppler Ratio with Fetal Distress in 38-40 Weeks of Gestation. Further, equations have been developed to calculate gestational age in a variety of breeds [6,7]. cesarean section: Definition A cesarean section is a surgical procedure in which incisions are made through a woman's abdomen and uterus to deliver her baby. Purpose of the tool: This tool describes the key perinatal safety elements related to safe cesarean section.The key elements are presented within the framework of the Comprehensive Unit-based Safety Program (CUSP). During the final days of gestation, cortisol is produced and released from the maturing fetal adrenal gland in response to space-constraint and other physiologic stressors. 1 The rate of TOLAC has decreased . 11) Verstegen-Onclin K, Verstegen J. Endocrinology if pregnancy in the dog: A review. Hence, it has been recommended that the decision-to-delivery interval should be within 30 mins. 1) Bergström A, Nødtvedt A, Lagerstedt AS, Egenvall A. Cesarean delivery is a major obstetrical surgical procedure aiming to save the lives of mothers and fetuses. Best Practice & Research Clinical Obstetrics & Gynaecology, https://doi.org/10.1016/j.bpobgyn.2012.09.005. Evaluation of decision to delivery time interval and its effect on feto-maternal outcomes and associated factors in category-1 emergency caesarean section deliveries: prospective cohort study. Anaesthesia. This RCOG guideline has now been archived. Background and Goal of Study: Regional anaesthesia (RA) is a first choice for category 1 to 3 urgency caesarean sections (CS). However, general anaesthesia (GA) is sometimes performed expecting shorter delivery time. 6) Yeager AE and Concannon PW. Both the capitalized and . Found inside – Page 262Category 1 Caesarean section (CS) may become category 2 with intrauterine fetal resuscitation and allow time for regional anaesthesia (RA). • Review regularly and optimize indwelling epidurals so that they may be topped up if required ... A cesarean section is the delivery of a fetus through an abdominal and uterine incision; technically, it is a laparotomy followed by a hysterotomy. women having a Caesarean Section. Guidelines for arranging for the presence of support person/s at a Caesarean section. Category-1 emergency caesarean section delivery is the commonly performed surgical procedure in pregnant women associated with significant mortality and morbidity both in the mother and fetus. Change ), You are commenting using your Facebook account. There are numerous causes of a raised core temperature. A fever occurring in sepsis may be associated with a survival benefit. However, this is not the case for non-infective triggers. 13) Zone MA and Wanke MM. 10) Concannon PW, Butler WR, Hansel W, Knight PJ, Hamilton JM. In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual ... Please see the RCOG guidelines section for more details: https://www.rcog.org.uk/en/guidelines-research-services/guidelines Training in teamwork and communication, availability of anaesthetists, and operation theatre are the main factors to achieve a quick caesarean delivery. Part 1: Physiology and Pre-anaesthetic Considerations) Use the lowest possible dose.
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