CAESAREAN SECTION TECHNIQUE

 

 

 

 
DIGITAL LOCATOR OF UTERUS FROM ABOVE (ABDOMEN)): Layer 1, skin of abdomen above the pelvic cavity; Layer 2 of fasciae of anterior abdominal wall; Layer 3 of rectus sheath; Layer 4 of parietal peritoneum and transversalis fascia; Layer 5 of peritoneal pelvic cavity; Layer 6 of pelvic peritoneum and fascia; Layer 7 of greater pelvis; Layer 8 of lesser pelvis; Roll over mouse to label; click to display pages and click blinking endpage to display uterus page

Video   Do it yourself   Automatic C sector                              Click here to obtain step by sep surgical technique

 

   
Caesarean section  

 

1 Wash your hands with soap and then scrub the hands thoroughly with savlon (or other scrubbing agent)

2 Put on sterile gloves and scrub the patient’s anterior abdominal wall skin thoroughly

3 Scrub the skin with savlon, spirit, then TBC or iodine in that order.

4 Rescrub your hands and ten gown and glove.

5 Proceed to place the simplest of the drapes on the anterior abdominal wall, allowing a small hole for incision.

6 A single sheet with a middle hole with suffice in most cases.

7 When everything is set (including trolley) make your first incision into the skin and clap major vessels in the subcutaneous tissue. An incision may be on the linea alba running form the umbilicus to the symphysis pubis or Pfannenstiel incision which is a curved transverse skin crease incision at the hypogastrium.

8  Identify the Scarpa’s and Camper’s fasciae and incise them (transversely in Pfannenstiel and longitudinally in linea alba incisions) together with linea alba.

9 Incise the anterior wall of rectus sheath

10.Separate the rectus muscle.

 11 Incise the posterior wall of rectus sheath only in linea alba incision. There is no posterior wall of rectus from midway between the umbilicus and the symphysis pubis (arcuate line of Douglas) and the symphysis pubis.

 12 Incise the parietal peritoneum longitudinally in both Pfannenstiel and linea alba incisions and enter the abdominal cavity.

 13 Put in two large abdominal packs with long tails held out with artery forceps into the two paracolic (paravertebral) gutters of the abdominal cavity. After this remove all swabs and use only large abdominal packs.

14 Incise the uterovesical peritoneum at the level of the lower segment of the uterus after clearing the bladder out of the way with the user of Doyen’s retractor.

15 Before incising the uterus, put a stay stitch on its lower portion to help identify this portion (i.e. the portion inferior to the incision) which usually slips under the bladder (at its posterior aspect) after the delivery of the baby.

16 Incise the uterus with a knife above your stay stitch and then widen your incision carefully with scissor. Avoid the extreme angles of the uterus and the broad ligament in order not to enter the uterine vessels or the ureters. Avoid widening the incision with your fingers; use knife carefully.

17 Suck up the amniotic fluid from the uterus vigorously with a suction machine- a simple foot operated machine will suffice

 18 Deliver the baby’s head into your uterine wound and proceed to give fundal pressure in order to push the baby out of the wound.

 19 Deliver the remains of the baby; clamp the cord in any two places separated by a small interval and divided between the your clamps.

 

 

 

20 Give the baby to the midwife or if present, the paediatrician.

 21 Ask the circulation nurse or the anesthetist to administer IV ergometrine 0.5mg after the delivery of the baby.

 22 Deliver the placenta by manual scooping from its uterine position. Proceed with vigorous suction of blood which will now make the entire field of operation very messy indeed.

 23 Apply Green-Amytage clamps to the edges of the uterine wound to control bleeding from the cut edges and suck the uterus

 24 After sucking the uterus dry, proceed to suture the two layers of he wound together. Start at one angle and proceed to the other.

 25 Use size 1 or 2 chromic catguts on round bodied stout needle.

 26 Hold the knotted sutures at the uterine angles of the wound on arterial clamps. Place two rows of stitches without locking. Always avoid the uterine mucosa as much as possible.

 27 Lock the first row of stitches and run the 2nd row of stitches without locking. Always avoid the uterine mucosa as much as possible.

 28 After the successful stitching of uterine wound, knot the two end stitches at the uterine angles.

 29 Mop the wound to see if there is further bleeding. If this occurs, proceed to give the Z-type of lock stitch in order to occlude the open vessel; first pass the needle in a longitudinal fashion and then transverse, then the knot. Make sure you take a god muscular bite.

 30 Reconstruct the uterovesical peritoneum using the Doyen’s retractor for proper visualisation.

 31 Remove the abdominal packs. Do a general toileting with warm saline and suction.

 32 Count all swabs and make sure no swab is unaccounted for (this is for the circulation nurse)

 33 Close the peritoneum with chromic 2/0 catgut using continuous stitches

34 Close up the anterior wall of rectus sheath with 1 chromic catgut using continuous stitches.

35 Approximate the Scarpa’s and Camper’s fasciae together using plain catgut 2/0 with interrupted stitches (this step may be avoided).

36 Stitch up the skin using silk with interrupted stitches. Use subcuticular stitches preferably with monofilament nylon for Pfannenstiel incision. Dress your wound with sterile gauze and tapes after mopping and cleaning with hibitane.

37 Perform a vaginal toileting with swab on sticks (swab on sponge holding forceps) three times.

 

 

 


Caesarean delivery

Caesarean delivery video Short delivery video - back

 

      
Pelvis female layer 4
DIGITAL LOCATOR OF UTERUS FROM BELOW (PELVIS): DIGITAL LOCATOR OF FEMALE PELVIS: Layer 1, layer of skin of female pelvis. Layer 2, layer of pelvic fascia. Layer 3 layer of greater pelvis, Layer 4, layer of lesser pelvis. Roll over mouse to label; click to display page. Then click blinking end page to display uterus page. Layer 4, layer of lesser pelvis containing uterus which is localised at Layer 4.

 

 

 

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