An exclusive production by the Sarawak General Hospital O&G Department on how to perform the C-Section
A step by step guide on how to perform the
- Review patient’s identification, indication for caesarean section and consent
- fill the OT checklist board correctly and prepare the antibiotics
- Area cleaned and drapped
- Test to ensure the spinal analgesia is in effect
- Identify and determine the incision site and size
- Use the scalpel to make the skin incision
- Abdomen opened in layers
- Secure any bleeders to prevent hematoma
- Open the peritoneum using two artery forceps
- Separate and push the rectus abdominis muscle lateraly for adequate exposure of the gravid uterus
- Apply the douyen retractor
- Identify the uterovesical fold and open this area using the non-tooth forceps and maxembun scissors
- Push the urinary bladder inferiorly and maintain retraction using the douyen retractor
- Incise the uterus using the blade initially until the whole thickness of the muscle
- Rupture the amniotic membrane using the artery forceps
- The incision can then be extended bilaterally by cutting the myometrium using the maxembum scissors
- Do not tear the myometrium bluntly
- Deliver the baby gently – fundal pressure may be employed to facilitate the delivery
- Clear the baby’s airway by suctioning
- Carefully cut the umbilical cord and ensure no other structure is caught in between
- The same procedure is then applied to deliver the second twin
- Suction and remove blood from the operative field
- Deliver the placenta by control cord traction
- Start Iv pitocin 40 units in 500ml normal saline
- Identify the incision site by applying the Armitage
- Apply the armitage at the angle of the incision & bleeding areas
- Explore the uterine cavity to remove any residual membrane and placenta tissue
- Start closing the uterine incision at the angle
- Make two bites at the angle
- Suture the first layer of the uterus using the continuous interlocking technique
- Apply the second suture and close the second layer using the continuous suture technique
- Ensure not to incorporate the bladder and visceral layer
- Exteriorize the uterus for better visualization while repairing
- Remove any blood clots from the peritoneum
- Inspect the fallopian tubes and ovaries
- Ensure haemostasis is secured
- Close the rectus sheat using the continuous suture technique
- Close the abdomen in layers
- The skin is closed using the subcuticular technique
- Clean the operative site and apply dressing
- Clean the perineum and remove residual blood clots from the vagina
An exclusive production by the Sarawak General Hospital O&G Department on how to perform the C-Section