CESAREAN SECTIO C/S – OBSTETRICS

Surgical technique

Low transverse incision through the skin
Small transverse incision strictly in the midline throuigh the subcutaneous tissue and fascia
Split the fascia by sliding a pair of slightly opened scissors transversely to the right and left.
That will spare the subcutaneous vessels avoiding unnecessary bleeding
Stretch the wound manually in a vertical direction
Open the peritoneum bluntly with your fingers
Stretch the wound further by manual traction in a transverse direction
Place a retractor distally in the wound
Apply downward traction to the retractor by assistant
Small transverse incision in the upper part of the lower segment of the uterus
Maintain a safe distance away from the bladder.
The more the lower segment is stretched, the higher the incision should be
3 to 5 fingers above the bladder.
Do not incise the bladder peritoneum and push down the bladder to make the incision low in the lower segment as described in many textbooks. That’s a recipe for troublesome vaginal tears.
Stretch the uterine incision manually in a transverse direction
Apply fundal pressure by assistant
Lift out the presenting part with
- One hand
- Sellheim’s Obstetrical Lever
- One blade of pair of ordinary obstetrical forceps
Deliver the baby
Clamp and cut the umbilical cord
Lift out uterus from the abdominal cavity
Squeeze out placenta by fundal pressure
Or remove it by hand from the uterine cavity
Close the incision in the lower segment with a continuous inverting suture from one corner of the incision to the other.
Use resorbable suture such as Chromic Catgut or Polyglycolic Acid.
One layer is enough.
Remove blood from the abdominal cavity
Return uterus into the abdomen
Close the fascia with a continuous suture
Close the skin