VCP 511: Gynaecology and Obstetrics Section

OPERATIVE TECHNIQUE

• After preparing the surgical site, local infiltration with anasthetic agent is done. View video... 
• Mostly left or right lower flank approach is perfered.
• An incision of about 10-12 inches is made on the skin.
• Then external oblique, internal oblique and transverse abdominus muscles are incised with blunt dissection.
• Peritoneum is cut with knife and incised with scissors. View video...
• Omentum may be pushed cranially or it may be incised.
• The gravid horn containing the fetus is identified.
• The incision is made on the greater curvature of the uterus by avoiding placentomes
• The fetus may be removed by caudal and lateral traction. View video...
• If the fetus is alive, resuscitation of the foetus may be carried out.
• After a live fetus has been removed the fetal membranes are left in the uterus.
• If the fetus is dead, the fetal membranes are removed manually if they separate away readily. Otherwise they are left within the uterus. Some of the fetal membranes may be trimmed away with scissors so that it does not interfere with the suturing of the uterus.
• Because of the high incidence of uterine infection and retained after birth following cesarean section, it is advisable to place 2-4 gm of oxytetracycline in the uterine cavity whether or not the fetal membranes are removed.
• The uterine incision is closed with a double row of lembert or cushing sutures using No.2 or 3 chromic catgut.
• In  uterine torsion cases,  correction of uterine torsion may be done after removal of fetus .
• The uterus should always be examined for the presence of twins, although they are rarely encountered in Cesarian section.
• Omentum followed by peritoneum is sutured with continuous suture using No.2. chromic catgut.
• Abdominal muscles are sutured with No.2 or No.3 chromic catgut by continuous lock suture or horizontal interrupted mattress suture.
• Skin incision is closed by simple interrupted or cross mattress or horizontal mattress suture using nylon or cotton thread. View video...
• Skin sutures are usually removed after 7 to 10 days.
• Post operative care with intravenous fluids, parenteral antibiotics, antihistaminics, analgesics are given.
• After the operation 30 to 50 units of oxytocin i/m and 300-450ml of calcium borogluconate i/v may be administered to aid uterine involution.