Lower Segment Caesarean Section

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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

  1. Review patient’s identification, indication for caesarean section and consent
  2. fill the OT checklist board correctly and prepare the antibiotics
  3. Area cleaned and drapped
  4. Test to ensure the spinal analgesia is in effect
  5. Identify and determine the incision site and size
  6. Use the scalpel to make the skin incision
  7. Abdomen opened in layers
  8. Secure any bleeders to prevent hematoma
  9. Open the peritoneum using two artery forceps
  10. Separate and push the rectus abdominis muscle lateraly for adequate exposure of the gravid uterus
  11. Apply the douyen retractor
  12. Identify the uterovesical fold and open this area using the non-tooth forceps and maxembun scissors
  13. Push the urinary bladder inferiorly and maintain retraction using the douyen retractor
  14. Incise the uterus using the blade initially until the whole thickness of the muscle
  15. Rupture the amniotic membrane using the artery forceps
  16. The incision can then be extended bilaterally by cutting the myometrium using the maxembum scissors
  17. Do not tear the myometrium bluntlyc-sec
  18. Deliver the baby gently – fundal pressure may be employed to facilitate the delivery
  19. Clear the baby’s airway by suctioning
  20. Carefully cut the umbilical cord and ensure no other structure is caught in between
  21. The same procedure is then applied to deliver the second twin
  22. Suction and remove blood from the operative field
  23. Deliver the placenta by control cord traction
  24. Start Iv pitocin 40 units in 500ml normal saline
  25. Identify the incision site by applying the Armitage
  26. Apply the armitage at the angle of the incision & bleeding areas
  27. Explore the uterine cavity to remove any residual membrane and placenta tissue
  28. Start closing the uterine incision at the angle
  29. Make two bites at the angle
  30. Suture the first layer of the uterus using the continuous interlocking technique
  31. Apply the second suture and close the second layer using the continuous suture technique
  32. Ensure not to incorporate the bladder and visceral layer
  33. Exteriorize the uterus for better visualization while repairing
  34. Remove any blood clots from the peritoneum
  35. Inspect the fallopian tubes and ovaries
  36. Ensure haemostasis is secured
  37. Close the rectus sheat using the continuous suture technique
  38. Close the abdomen in layers
  39. The skin is closed using the subcuticular technique
  40. Clean the operative site and apply dressing
  41. 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