Heating up caesarean care – tackling perioperative hypothermia

Abstract

Optimising care for women who undergo caesarean delivery in low- to middle-income settings (LMIC) presents unique challenges, one of which is the risk of perioperative hypothermia, defined as a core body temperature below 36 °C (96.8 °F). Although, caesarean delivery is a relatively short procedure, it has been estimated that inadvertent hypothermia can occur in up to 80% of women who receive spinal anaesthesia.¹ Reasons for this include peripheral vasodilation, diminished regulatory vasoconstriction, and reduced shivering responses that promote /heat redistribution during neuraxial anaesthesia, with patients who have higher sensory block levels being particularly vulnerable.^2,3,4 The effect of perioperative hypothermia in women undergoing caesarean delivery has been incompletely studied. However, in the general surgical population it can have significant consequences including increased blood loss, wound infection, cardiovascular complications, and extended hospital stay.^5,6 Maternal hypothermia also has implications for the neonate; this is particularly relevant for caesarean delivery as it has been established that for healthy term neonates, caesarean delivery causes a less favourable thermal response to birth than vaginal delivery.⁷ Maternal hypothermia may result in decreases in neonatal temperature and neonatal hypothermia, even in tropical environments. While neonatal hypothermia is rarely a direct cause of death, it does contribute to a substantial proportion of neonatal morbidity and mortality globally.^8,9 The role of minimising unintentional perioperative hypothermia in improving outcomes has been recognised in guidance from the United Kingdom (UK) and United States of America.^10,11