What is the rationale behind count during a cesarean section?

The primary reason for performing a count during a cesarean section is to ensure the complete removal of surgical items, such as sponges, instruments, and needles, from the patient's body. Retaining any foreign objects within the surgical site can lead to serious complications, including infection, inflammation, and tissue damage. The absence of a complete count can result in significant medico-legal consequences.

To ensure the safety of the patient and facilitate accurate counting during the procedure, the following steps are typically followed:

1. Preoperative Preparation: Before the surgical incision is made, a designated member of the surgical team, often a nurse, takes an initial count of all surgical items. This count includes sponges, instruments, and needles. The count should be recorded on the surgical record.

2. During Surgery:

- Sponges: Throughout the surgical procedure, the surgical team members are responsible for maintaining a continuous count of sponges. Each time a sponge is used, it is recorded, and its removal from the surgical field is confirmed. This count is typically done aloud and verified by another team member.

- Instruments and Needles: The surgical team also maintains a count of all surgical instruments and needles. This count is typically done in sets. Before the incision is closed, a final count of the instruments is performed to verify the presence of all used items.

3. Closure and Post-operative Confirmation: Before the surgical incision is closed, the surgical team performs a final confirmation of the count. This involves a physical reconciliation of the surgical items removed from the patient's body to ensure that all used sponges, instruments, and needles are accounted for. The final count is recorded on the surgical record.

4. Documentation: The final count, along with the initial count recorded during preoperative preparation, is documented in the surgical record. Any discrepancies or concerns related to the count are addressed immediately during the surgery itself or during the post-operative period.

By following these protocols and maintaining accurate counts, surgical teams aim to minimize the risk of unintentionally leaving foreign objects inside the patient during a cesarean section.