Establishment of Indication for 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
 |
| 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.
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