Detailed steps of cesarean section

Cesarean section is a method of delivery. For women who have difficulty in natural delivery or who have risks of natural delivery, cesarean section can be used to deliver the baby. When performing a cesarean section, it must be performed in a regular hospital. The surgical method of cesarean section is also relatively simple. It mainly involves cutting the abdominal wall, pulling out the uterus, then cutting the uterus, pulling out the fetus, then removing the placenta, and finally suturing the uterus and the abdominal wall.

Detailed steps of cesarean section

(1) Incision of the abdominal wall:

After the operation site is determined, the surgeon will clean, shave, disinfect and anesthetize the area as usual, then make an arc-shaped incision, and then cut the skin and muscles, external oblique muscles, internal oblique muscles, transverse abdominal muscles and their fascia in layers. Any blood vessels should be avoided or double ligated. Then cut the peritoneum. When cutting the abdomen, you must use tweezers to pick it up and cut a small hole. Then the operator inserts the middle finger or index finger of the left hand into the incision, and under the guidance of the left hand, cut the peritoneum to the appropriate length to expose the rumen.

(2) Pulling out the uterus:

After peritoneal incision, the surgeon's arm should be disinfected again and rinsed with saline before being inserted into the abdominal cavity to examine the uterus, fetus, and nearby organs to detect any ruptures or adhesions. Then have an assistant move the rumen forward to expose the uterus. The pessary is pushed out of the incision. When pulling the uterus, move slowly and at an angle. Excessive force can easily tear the uterus. After the uterus is pulled out, a large piece of multi-layer sterile gauze should be placed between the uterus and the edge of the incision to prevent the fluid in the uterus from flowing into the abdominal cavity and causing infection.

(3) Uterine incision:

After identifying the greater curvature of the uterine horn, avoid the uterine caruncle and cut through the uterine wall with one cut. After fully ligating the bleeding point of the uterine wall incision, carefully separate the fetal membrane near the incision. If the membrane is full of amniotic fluid, make a small cut to release the amniotic fluid first. Choose the appropriate location and direction for releasing the tire water. After part of the amniotic fluid has been released, use scissors to extend the amniotic membrane incision and flip the cutting edges on both sides toward the sides of the uterine incision and fix them. In this way, the cutting edges of the everted amniotic membrane form a biological wound, and the amniotic fluid will not leak into the abdominal cavity when it flows out, causing contamination.

(4) Pulling out the fetus:

When taking out the fetus, grab the tarsal part of the fetus' hind limb or the wrist of the forelimb along the uterine incision and slowly pull out the fetus in the most suitable direction and angle. If the incision is too small, it can be enlarged. After pulling out the fetus, the assistant should secure the uterus to prevent it from retracting into the abdominal cavity. The pulled out fetus is cared for as a calving cow.

(5) Peeling off the afterbirth:

The principle of treatment is that if it can be peeled off, it should be completely peeled off. If it cannot be peeled off, the detached part should be cut off, and the rest should be left in the uterus to fall off and be discharged on its own. However, the fetal membranes near the edges of the incision on both sides must be peeled off and cut off, otherwise it will hinder suture.

(6) Suturing the uterus:

Before suturing the uterus, anti-inflammatory powder should be evenly spread inside the uterus. The uterus is usually closed with two sutures, the first is a full-thickness continuous suture, and the second is a serosal and muscular layer embedding suture. In order to accelerate uterine healing and hemostasis and facilitate the discharge of lochia, 5 to 10 units of posterior pituitary hormone can be injected into the uterine cavity before suturing.

(7) Suturing the abdominal wall:

The abdominal cavity should be carefully cleaned before suturing the abdominal wall. After the abdominal wall incision is prepared, the peritoneum is sutured first, usually with intestinal sutures for continuous suture. Before the peritoneum is sutured, antibiotic oil should be injected into the peritoneum through the incision to prevent infection and adhesion. The muscles are then sutured continuously, layer by layer. Finally, the skin is sutured with nodules. When suturing the skin, the wound edges should be turned inward, otherwise it will affect wound healing and prolong the treatment period. After suturing, the surgical area should be coated with iodine tincture or anti-inflammatory ointment, then the restraint should be removed and the patient should be helped to stand.