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Ob Orientation > C-Section > Flashcards

C-Section Flashcards

1
Q

What position should the patient be in for C-section?

A

Left lateral tilt; place wedge under R side

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2
Q

What area should be prepped with iodine or chlorhexidine?

A

From incision to xiphoid and down to thighs

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3
Q

What instrument do you use to check for adequate anesthesia?

A

Allis clamp

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4
Q

Where should you make the skin incision?

A

2cm superior to pubic symphysis

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5
Q

What do you use to make the skin incision?

A

10 blade

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6
Q

What do you use to cut the subcutaneous fat?

A

Bovie on coagulation

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7
Q

What are the layers of fascia in the subcutaneous layer?

A

Camper’s fascia (fatty, more superficial) and Scarpa’s fascia (membranous, below Camper’s)

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8
Q

How you do make the incision in the fascia?

A
  1. Bluntly dissect remaining subcutaneous fat
  2. Use the Bovie or 10 blade to score the fascia in the midline
  3. Use a Kelly under the fascia to lift away from muscle while assistant cuts with Bovie
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9
Q

What muscle lies below the fascia?

A

Abdominis rectus muscle; pyrimidalis located inferiorly

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10
Q

What muscular aponeuroses make up the fascia?

A

External oblique, internal oblique, and transverse abdominis

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11
Q

How do you separate the rectus muscle from the fascia?

A
  1. Attach 2 Kochers to inferior edge of fascia for tension
  2. Bluntly dissect with fingers
  3. If needed, use Bovie to cut fascial attachment at midline to the level of the pubic symphysis
  4. Repeat superiorly to umbilicus
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12
Q

What are the attachments of the pyrimidalis muscle?

A

Pubic symphysis and linea alba

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13
Q

How do you make the incision in the peritoneum?

A

Either:
1. Bluntly dissect with fingers, stretching the incision with both hands
2. Tent with a hemostat then cut with Metzenbaums

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14
Q

When do you place the bladder blade?

A
  1. After cutting the peritoneum, before cutting into the uterus
  2. Before repairing the uterine incision
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15
Q

When do you locate the baby’s head?

A

After cutting the peritoneum, before placing the bladder blade/cutting into uterus

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16
Q

What is the formal name of the bladder blade?

A

Balfour retractor

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17
Q

What do you use to make the incision in the uterus?

A

10 blade (different one from skin incision to make sure it’s sharp)

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18
Q

How big should you make the uterine incision?

A

2-3cm wide but shallow with the blade, then dissect bluntly to extend (poke finger in, pull cephalad and caudad)

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19
Q

How do you deliver the baby?

A
  1. Insert hand and cup baby’s head (should feel occiput)
  2. Using a straight arm and wrist, pull upwards
  3. Check for nuchal cord
  4. Deliver shoulders (anterior then posterior)
  5. Catch the rest of the body!
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20
Q

What should you do as soon as the baby is delivered?

A
  1. Suction baby’s mouth and nose
  2. Clamp cord (+/- delayed clamping)
  3. Cut cord
  4. Pass baby
  5. Get cord blood
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21
Q

How do you manage the 3rd stage of “labor” during a C-section?

A
  1. Start pitocin at 20U
  2. Deliver placenta
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22
Q

How do you deliver the placenta?

A

Either:
1. Manually peel the placenta along the plane while providing tension on the cord
2. Massage the uterus and apply tension to the cord

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23
Q

What instrument can you use if placental membranes are left behind?

A

Grab with Kelly clamp

24
Q

When do you exteriorize the uterus?

A

After delivery of the placenta

25
Q

How do you ensure good hemostasis after delivery of the placenta?

A
  1. Exteriorize the uterus and wrap it in moist lap
  2. Use 2 dry laps to sweep inside the uterus
26
Q

What clamps do you use when repairing the uterine incision?

A
  1. Two Allis clamps at lateral edges
  2. Two Allis Adair/T clamps on superior and inferior edges
27
Q

What suture do you use to repair the uterine incision?

A

1-0 Vicryl

28
Q

What instruments do you need to suture the uterine incision?

A
  1. Straight needle driver
  2. 1-0 Vicryl
  3. Russian pick ups
  4. Hemostats to hold long ends of suture at start and end of repair
29
Q

Do you repair the uterus while it is exterior or interior?

A

Exterior

30
Q

What do you do before replacing the uterus in the abdominal cavity?

A

Clean using a moist lap with suction

31
Q

How do you replace the uterus in the abdominal cavity?

A

Turn sideways and be sure to protect tubes and ovaries

32
Q

What should you do after replacing the uterus?

A

Check for bleeding by retracting abdominal walls with Richardson, then use wet lap with suction to clean in side gutters

33
Q

When do you remove the hemostats holding the ends of the uterine incision repair?

A

After replacing the uterus in the abdominal cavity and checking for bleeding in cavity or along uterine incision

34
Q

Do you repair the peritoneum?

A

Maybe but not necessary

35
Q

What instruments do you need to repair the fascia?

A
  1. Two Kocher clamps to grab the angles of the incision
  2. Army-Navy retractors
  3. Straight needle driver
  4. 0-Vicryl or loop PDS-1
  5. Rat-tooth pickups
36
Q

What suture do you use to repair the fascia?

A

0-Vicryl or loop PDS-1

37
Q

Do you check for hemostasis while incising the subcutaneous layer or repairing?

A

Both

38
Q

You’ve just repaired the fascia; what do you call for?

A

Sloppy wet and dry laps (to clean), then use Bovie to cauterize bleeders

39
Q

When should you repair the subcutaneous layer?

A

When >2cm of tissue (thicker fat layer)

40
Q

What suture do you use to repair the subcutaneous layer?

A

2-0 Vicryl Rapide

(Rapide is irradiated and absorbs more quickly than regular Vicryl)

41
Q

What is the benefit of repairing the subcutaneous layer?

A
  1. Help prevent seroma formation
  2. Decrease tension on skin incision
42
Q

What instruments do you need to repair the skin incision?

A
  1. Needle driver
  2. 3-0 Monocryl on Keith (straight) needle or 4-0 Monocryl on curved needle
  3. Pickups
43
Q

What kind of suture should you use to repair the skin incision?

A

Either:
1. 3-0 Monocryl on Keith needle
2. 4-0 Monocryl on curved needle

44
Q

What steps should you take after closing the skin incision?

A
  1. Remove drapes
  2. Clean
  3. Apply pressure dressing
  4. Express uterus (and clean again)
  5. Move to PACU
45
Q

What do you call for to make the skin incision?

A

10 blade

46
Q

What do you call for to cut the subcutaneous layer?

A

Nothing (use Bovie and blunt dissection)

47
Q

What do you call for to make the fascial incision?

A

Kelly (to lift fascia away from muscle; cut with Bovie)

48
Q

What do you call for to separate fascia from muscle?

A

Two Kochers

49
Q

What do you call for after dissecting the peritoneum?

A

Bladder blade

50
Q

What do you call for to make the uterine incision?

A

10 blade

51
Q

What do you call for after delivering the baby?

A
  1. Suction bulb
  2. Two Kelly’s (for clamping the cord)
  3. Bandage scissors
  4. Ask anesthesia to start pit at 20U
52
Q

What do you call for after delivering the placenta?

A
  1. Moist lap (to exteriorize uterus)
  2. Two dry laps (to sweep inside uterus)
53
Q

What do you call for after exteriorizing the uterus?

A
  1. Two Allis’s
  2. Two T clamps
  3. 1-0 Vicryl on straight needle driver
  4. Russian pickups
  5. 2 Kelly’s (for holding ends of sutures)
54
Q

What do you call for after replacing the uterus in the abdominal cavity?

A
  1. Wet lap (to check for bleeding/clean in side gutters)
55
Q

What do you call for after repairing the uterus?

A
  1. Wet lap (to check for bleeding/clean in abdominal cavity before replacing uterus)
56
Q

What do you call for after uterus is replaced and side gutters are cleaned?

A
  1. Two Kocher’s
  2. Two Army-Navy’s
  3. 0 Vicryl or loop PDS-1 on straight needle driver
  4. Rat tooth pickups
57
Q

What do you call for after repairing the fascia?

A
  1. Sloppy wet and dry laps (clean, then check for hemostasis)

Ob Orientation (1 decks)

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