Tag: c/s

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

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CHALLENGES WITH CESAREAN SECTIO

FULL BLADDER

Empty bladder by suprapubic puncture

DEEPLY IMPACTED HEAD

There are two options:

1. Have an assistant push the head from below with a hand in vagina

2) Perform internal version and extraction on a foot through the uterine incision

LATERAL TEARS OF THE UTERINE INCISION

• Close the wound with two continuous sutures
• Start suturing separately in each corner
• Tie the sutures together in the midline

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BLEEDING FROM UTERINE ARTERY

• Clamp the artery above and below the bleeding point
• Apply suture-ligation

MYOMA

• Make the uterine incision in a convenient place
• Avoid the myoma(s) in the incision
• Do not try to shell out or remove the myoma(s)
• It may cause torrential and fatal bleeding.

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HIV POSITIVE PATIENT:

• Use protection
• Give prophylactic medication before surgery

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ABDOMINAL PACK

• Be sure to remove all abdominal packs before wound closure
• Suspect retained pack in septic complications

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