There are a multitude of reasons that a caesarean section extraction could be difficult, including a lower segment that is difficult to access, complex fetal positioning, abnormal placentation, or injuries to other organs in the abdomen. Maternal body habitus, as well as multi-fetal pregnancies present additional management considerations and technical…
Summary Beware preterm labour, malpresentation, PPROM Mentally prepare. You have the skill set! Do a classical incision rather than risk lateral extension of a transverse incision Inverted T incision if your lower segment incision does not allow necessary maneuvers Anticipate the thickness of the upper segment and the the possibility of going through an anterior placenta. Closure…
Abdominal Incision: Vertical Midline The lower abdominal midline incision should be employed if optimal exposure is desired. It is generally thought to be faster and easier to perform in the case of an emergency classical cesarean section. It can be easily extended to afford exposure of the entire peritoneal cavity….
Dr. Margaret Burnett Learning Objectives Recognize risk factors for classical uterine incision Mentally prepare with confidence Anticipate the differences in technique between LSCS and Classical CS Troubleshoot pitfalls encountered Classical CS Our objective is to give you the basics of performing a classic cesarean section. By the end of the…
Approach to Management of PPH following Cesarean Section I. Cesarean Section Delivery with 1000-1500mL estimated blood loss, with ongoing excessive bleeding and/or mild tachycardia and/or hypotension. Consider 4 T’s: Tone: GA may cause uterine atony ,prolonged labour, chorioamnionitis, polyhydramnios Tissue: rule out abnormal placentation Trauma: Manual and visual exploration of…
Setup for Repairing Lower Genital Tract Lacerations Materials for Repairing Lacerations For all repairs Additional, for Higher Order or Complex tears Sterile drapes and gloves Foley catheter Irrigation solution (warm sterile saline or water) Allis clamps (for anal sphincter repairs) Needle driver Ring forceps (for cervical repairs) Suture scissors Tissue…
Delivery of the Head Slide your fingers between the head and the lower part of the incision Keep your hand stiff so it forms a “slide” for the baby’s head while the assistant pushes on the uterine fundus Don’t fight the contraction, direct the head through the incision during relaxation phase Assistant may push…
Lower Segment (Transverse) Thin myometrium therefore less blood loss, quicker entry Lower risk of catastrophic uterine rupture in future pregnancies Width is restricted by uterine arteries and Azygos plexus May have to create a “T” incision to obtain adequate exposure The choice of uterine incision largely depends on the indication…
Modules Prioritized (complete) Modules Assigned, with planned review date (goal 4 weeks) Content Creator makes initial documents (Word, PowerPoint, etc) Initial documents circulated to reviewers (curriculum working group, current residents, etc) and comments / edits are made in online version of Word, PowerPoint files (goal 2 weeks) Content Creator makes…