C/S

Question 1

Initial prep/steps of C/S

Answer 1

1. Adequate anesthesia (general, neuraxial, etc.)

2. Foley catheter, prophylactic Abx, pt should be supine w/ leftward tilt

Question 2

Overall Steps of C/S

Answer 2

1. abdominal entry
2. hysterotomy
3. delivery
4. closure

Question 3

Abdominal entry variations

Answer 3

-general: low, transverse
-Pfannenstiel (most common)—3 cm above the pubic symphysis & slightly curved
upward. Fascia is incised transversely & dissected off underlying rectus muscles.
Rectus muscles separated in the midline.
-Cohen incision – 3–4 cm above the symphysis. Fascia incised in the midline, extension
of the fascial incision, separation of rectus, & entry to peritoneum done bluntly.

Question 4

Hysterotomy step

Answer 4

Generally transverse in lower uterine segment, 2 cm above the bladder
margin. Can extend bluntly or w/ bandage scissors. Alternatives include low
vertical incision or classical incision (vertical incision extends to upper uterus).

Question 5

C/S delivery step

Answer 5

1. Slide hand below the infant’s head & elevate it to the level of the incision.
   Apply fundal pres to facilitate deliv. If breech, deliver legs, rotate body to deliver
   shoulders & arms, deliver head.
2. Deliver placenta w/ uterine massage or manually. Clear uterus of clot & placental
   tissue

Question 6

Closure

Answer 6

1. Close hysterotomy in 1 or 2 layers. The 1st layer closure is performed w/ a running,
   locking stitch. An imbricating, running stitch may then be used.
2. Reapproximate fascia w/ a running, delayed-absorbable or permanent suture
3. Close subcutaneous layer if >2 cm thick; close skin w/ subcuticular suture or
   staples