Abstract：
Preoperative preparation for cesarean delivery is a multistep approach for which protocols should exist at each hospital system. These protocols should be guided by the findings of this review. The interventions reviewed and recommendations made for this review have a common goal of decreasing maternal and neonatal morbidity and mortality related to cesarean delivery. The preoperative period starts before the patient\'s arrival to the hospital and ends immediately before skin incision. The Centers for Disease Control and Prevention recommends showering with either soap or an antiseptic solution at least the night before a procedure. Skin cleansing in addition to this has not been shown to further decrease rates of infection. Hair removal at the cesarean skin incision site is not necessary, but if preferred by the surgical team then clipping or depilatory creams should be used rather than shaving. Preoperative enema is not recommended. A clear liquid diet may be ingested up to 2 hours before and a light meal up to 6 hours before cesarean delivery. Consider giving a preoperative carbohydrate drink to nondiabetic patients up to 2 hours before planned cesarean delivery. Weight-based intravenous cefazolin is recommended 60 minutes before skin incision: 1-2 g intravenous for patients without obesity and 2 g for patients with obesity or weight ≥80 kg. Adjunctive azithromycin 500 mg intravenous is recommended for patients with labor or rupture of membranes. Preoperative gabapentin can be considered as a way to decrease pain scores with movement in the postoperative period. Tranexamic acid (1 g in 10-20 mL of saline or 10 mg/kg intravenous) is recommended prophylactically for patients at high risk of postpartum hemorrhage and can be considered in all patients. Routine use of mechanical venous thromboembolism prophylaxis is recommended preoperatively and is to be continued until the patient is ambulatory. Music and active warming of the patient, and adequate operating room temperature improves outcomes for the patient and neonate, respectively. Noise levels should allow clear communication between teams; however, a specific decibel level has not been defined in the data. Patient positioning with left lateral tilt decreases hypotensive episodes compared with right lateral tilt, which is not recommended. Manual displacers result in fewer hypotensive episodes than left lateral tilt. Both vaginal and skin preparation should be performed with either chlorhexidine (preferred) or povidone iodine. Placement of an indwelling urinary catheter is not necessary. Nonadhesive drapes are recommended. Cell salvage, although effective for high-risk patients, is not recommended for routine use. Maternal supplemental oxygen does not improve outcomes. A surgical safety checklist (including a timeout) is recommended for all cesarean deliveries.
摘要：
剖宫产术前准备是一个多步骤的方法，每个医院系统都应采用该方法。这些协议应以本次审查的结果为指导。本综述所审查的干预措施和建议具有降低与剖宫产（CD）相关的孕产妇和新生儿发病率和死亡率的共同目标。术前时间段在患者到达医院之前开始，并在皮肤切口之前立即结束。除了CDC建议至少在手术前的晚上用肥皂或消毒液淋浴之外，皮肤清洁还没有显示出进一步降低感染率。在剖宫产皮肤切口脱毛是没有必要的，但是，如果手术团队愿意，则应使用修剪或脱毛乳膏而不是剃须。不建议术前灌肠。澄清的流质饮食可以在CD前2小时摄取，清淡的饮食可以在CD前6小时摄取。考虑在计划的CD前2小时给予非糖尿病患者术前碳水化合物饮料。建议在皮肤切口前60分钟以体重为基础的静脉（IV）头孢唑林：无肥胖患者为1-2gIV，肥胖或体重≥80kg的患者为2g。对于分娩或胎膜破裂的患者，建议静脉内服用阿奇霉素500mg。术前加巴喷丁可以被认为可以降低术后运动时的疼痛评分。氨甲环酸（在10-20mL盐水中1g或10mg/kg静脉注射）建议对产后出血高危患者进行预防性治疗，并且可以在所有患者中考虑。建议术前常规使用机械静脉血栓栓塞预防，并持续到患者门诊。音乐,患者的主动变暖，适当的手术室温度可以改善患者和新生儿的预后，分别。噪音水平应允许团队之间的清晰沟通，然而，数据中尚未定义特定的分贝水平。与右侧倾斜相比，左侧倾斜的患者定位可减少低血压发作，这是不推荐的。手动移位器导致比左侧倾斜更少的低血压发作。阴道和皮肤准备应使用氯己定（首选）或聚维酮碘进行。没有必要放置留置导尿管。建议使用非粘性窗帘。细胞抢救,虽然对高危患者有效，不建议用于常规使用。母亲补充氧气并不能改善结果。对于所有CD，建议使用手术安全检查表（包括超时）。
