This document provides an overview of the key steps in a Cesarean section (CS) procedure. It discusses preoperative preparation including positioning the patient on their left side. It describes spinal or general anesthesia options. The surgical technique involves making a vertical or transverse abdominal incision and then a low transverse uterine incision. The infant is gently delivered and the cord is clamped. The placenta is then manually removed if not delivered spontaneously. The uterine incision is closed with absorbable sutures. In some cases a hysterectomy may be required as part of the procedure due to complications.

1. Cesarean section
Procedure
Presented by :Jaber Manasia

2. Preoperative preparation for CS
• Full blood count and haemoglobin
• Cross match
• Routine ultrasound before CS
• Urinary catheter use at CS
• Preoperative shaving

3. • All patients transferred to theatre must be in the left
lateral position (to pre ve nt ‘ supine hypo te nsio n’ and
fe tal distre ss) ;
• Premedication with antacid is standard;
• In the theatre or operating room must also be kept in the
left lateral tilt position until after delivery;
• Thromboprophylaxis should be given for all patients
and prophylactic antibiotics should be given.
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4. Anesthesia
• A woman may be given spinal anesthesia for the procedure,
or she may have a general anesthesia.
• Spinal anesthesia is similar to an epidural, where a needle is
inserted into the fluid that surrounds the spinal cord so that
there is no sensation from the chest down.

5. Anesthesia
• Some women may require general anaesthesia during the
caesarean, & This is sometimes necessary when the baby
must be delivered quickly

6. Surgical technique for cs

7. Abdominal-wall incision
• The vertical incision should be
performed in the midline extending
form just below the umbilicus to a
point approximately 2 cm above the
symphysis
• The transverse (pfannenstiel)
incision should extend transversely
for approximately 15cm at a point 2
cm above the symphysis

8. Vertical
VS. Transverse
Faster
Slower
More exposure
Less exposure
less attractive
Cosmetically more
attractive
High possibility of
dehiscence
Low possibility of
dehiscence

9. Uterine incision
Low transverse incision
• This is the most common
uterine incision
• It has much less
bleeding than the
classical incision
• It heals better, and less
likely of dehiscence

10. Uterine incision
Low transverse incision
• It is very important to make the
uterine incision large enough to
allow delivery of the head and trunk
of the fetus without tearing or cut the
uterine arteries and veins that
course through the lateral margins of
the uterus.

11. Uterine incision
Low transverse incision
• If the placenta is encountered in the line
of incision, it must be either detached or
incised. When the placenta is incised,
fetal hemorrhage may be severe; thus,
delivery and cord clamping should be
performed as soon as possible in such
cases

12. Delivery of the Infant
• In a cephalic presentation, a hand is
slipped into the uterine cavity between
the symphysis and fetal head, and the
head is elevated gently with the fingers
and palm through the incision, aided by
modest transabdominal fundal pressure

13. Delivery of the Infant

14. Delivery of the Infant
• To minimize fetal aspiration of amnionic
fluid, nose and mouth are aspirated with a
bulb syringe before the thorax is
delivered. The shoulders then are delivered
using gentle traction plus fundal pressure
• The rest of the body readily follows.

15. Delivery of the Infant
• After the shoulders are delivered, an intravenous
infusion containing about two ampules or 20 units
of oxytocin per liter of crystalloid is infused at 10
mL/min until the uterus contracts, after which the
rate can be reduced.

16. Delivery of the Infant
• After delivery of the baby the cord is clamped
• the infant is given to the team member who will
conduct resuscitative efforts as needed
• The uterine incision is observed for any excessive
bleeding sites.

17. Placental delivery
• The placenta is then delivered unless it has already
done so spontaneously.
• Or by manual removal .
• Fundal massage, begun as soon as the fetus is
delivered.

19. Repair of the Uterus
• The uterine incision is then
closed with one or two layers
of continuous 0 or number 1
absorbable suture

21. Uterine incision
Classical (upper segment) incision
• Rarely done nowadays
• More bleeding
• Worse healing, and more
likely of dehiscence

22. Caesarean Hysterectomy
Caesarean section and hysterectomy are
sometimes performed at the same time,
e.g. where there is uterine rupture,
placenta accreta, uncontrollable
postpartum haemorrhage, and in the
cases of cervical malignant disease.

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