Cesarean Section: Everything You Need to Know

Incision and Dissection 

Cesarean delivery should be done strictly in the operating room. The procedures vary based on the patient’s conditions and the medical practices of the doctor. It is recommended that the incision be done at with the regional anesthesia, particularly at the spinal code. The doctor first asks the patient to undress completely and put on a hospital gown. She is then placed in an examination table after which a urinary catheter is inserted. Note that this is only done in case the catheter was not put in before the patient moved into the operating room. The doctor then starts an intravenous line in the patient’s arm or hand and straps are placed over her legs to ensure that the legs remain in a stationary position on the table and for general safety reasons. The doctor should ensure that he/she clips all the hair around the surgical area and clean the skin using an antiseptic solution (Stanford Children’s Health, 2020). Before incision, it is recommended to drape the patient’s abdomen with a sterile material while at the same time, placing it around the chest for the screening of the surgical site. The anesthesiologist can then slightly feel the rate of blood flow at the wrist using his/her middle and index fingers while counting the number of heartbeats every second to monitor the patient’s heart rate. This is followed by continuous monitoring of blood pressure, breathing rate, and the levels of oxygen in the blood. 

After ensuring that the anesthesia has taken effect, the doctor can now make an abdominal incision. The incision should be made slightly above the pubic bone in either a transverse or vertical angle (Stanford Children’s Health, 2020). The patient, at this stage, can hear the sound of an electrocautery machine. The machine is used to seal off bleeding although deeper incisions may target both tissues and muscles while trying to reach the uterine wall. The last incision is made inside the uterus although it should neither be transverse or vertical. The doctor will open the amniotic sac to deliver the baby through the opening, a point in time that is accompanied by increased pressure and a pulling sensation in the uterus. 

The umbilical code is then cut and the doctor gives a medication that helps in the contraction of the uterus as well as the expulsion of the placenta (Stanford Children’s Health, 2020). The placenta is eventually removed and a thorough analysis of the uterus is done to locate any pieces of placenta that might have remained inside. The doctor then uses sutures to close the incision made in the uterine muscle and ensuring that he/she repositions the uterus to fit in the pelvic cavity. The muscles and tissue layers and eventually closed using sutures and closing the skin incision by the use of surgical staples. Finally, a sterile bandage is applied to protect the wound from pathogens. 

Closure 

The closure can be performed using double-layer techniques to ensure a continuous interlocking and then imbricating the layer that follows immediately. The uterus is closed by the use of a delayed absorbable suture polyglactin 910 (0) while modifying the single layer and excluding the decidual one (Babu, & Magon, 2012). A full-thickness needle bite connects the margin of the incision to the decidua of the lower edge. A superficial bite is the taken and it should encircle the outer margins. At this point, the needle bite should connect the peritoneal fascia and outer myometrium from the lower edge and the upper edge then follows later. The third stage is the formation of two loose loops at the ends of the cranial and the caudal while pooling the latter loop and simultaneously tightening the former one (Babu, & Magon, 2012). To tighten the caudal loop, the surgeon will pull the thread while maintaining traction. 

References 

Babu, K. M. & Magon, N. (2012). Uterine Closure in Cesarean Delivery: A New Technique. N Am J Med Sci ., 4(8): 358–361. Bethesda MD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421915/ 

Stanford Children’s Health. (2020). Cesarean Delivery (Cesarean Section, C-section, Cesarean Birth). Stanford Medicine. Retrieved February 15, 2020, from https://www.stanfordchildrens.org/en/topic/default?id=cesarean-delivery-92-P07768