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Thursday, April 5, 2018

12 Steps of Cesarean section




Preoperative preparation
·         Investigations: Blood : Hb, Coagulation profile, Serology, Blood group, Renal Fucntion test
·         Arrange II pint of whole blood and Cross match
·         Take Consent
·         Inform Anaesthesiologist
·         Inform Neonatologist/ Pediatrician

Intra operative preparations
·         Position: Supine
·         Wide bore canulation
·         Catherization
·         Preoperative medications including Antibiotics, gastroprotective agents
·         FHS Monitoring
·         Anaesthesia: Spinal/ General

Surgical Steps
Painting and draping  Lower abdominal inscision Soft tissue dissection and abdominal cavity reached. Doyen’s retracter is introduced and abdominal cavity is packed.  Identification of lower uterine segment and extraperitoneal incision is made over the uterine muscle. Membarane is ruptured, liquor suctioned and muscles spilt across. Fetal head  identified, doyen’s retracter removed and  baby  delivered. Doyen’s retractor reintroduced. Controlled cord traction of placenta.  Wound margin picked using hemostatic clamp  Uterine incision is sutured in 3 layers continuously using absorbable suture. Skin is closed in layers and dressing done. Wound packed.
12 steps of Cesarean section
1.       Painting and Draping
2.       Incision : Lower abdominal (Pfennestial) / midline vertical/ paramedian vertical
3.       Soft tissue dissection and opening of peritoneal cavity
4.       Doyen’s retracter is introduced and abdominal cavity is packed.
5.       Identification of Lower uterine segment and extraperitoneal incision is made over the uterine muscle.
6.       Membarane is ruptured, liquor suctioned and muscles spilt across.
7.       Fetal head is identified, Doyen’s retracter removed and  baby is delivered. Cords clamped and cut. Baby transferred.
8.       Doyen’s retractor reintroduced.
9.       Controlled cord traction performed and placenta removed. IV oxytoics provided.
10.   Wound margin picked using four Allis Forceps or green Armytage hemostatic clamp
11.   Uterine incision is sutured in 3 layers continuously using absorbable suture.
12.   Skin is closed in layers and dressing done. Wound packed.

Post operative care
·         Monitor: BP, Pulse, RR, Temperature, Fluid Input, Urine Output, Abdominal distension
·         Provide IV fluid, analgesics, Antibiotics, Oxytoxics
·         Breastfeed as early as mother is stable.
·         Ambulate as early as mother can tolerate
·         Start on sips as bowel sound appears, increase gradually to soft to solid food over 2-3 days.
·         Avoid coughing, straining and exertional work.
·         Wound dressing every 3-4 days and suture removal on Day 5-7.
·         Patient can be discharged once patient is stable and can take care of wound and diet.