November 14, 2017

Before Your First: Cesarean Section

25 minutes

Whether it's scheduled or called urgently during labor, the cesarean section is one of the most common surgeries you'll see on Ob/Gyn. This episode covers the indications, abdominal wall anatomy layer by layer, the key surgical steps from hysterotomy to closure, and how you can be the most helpful in the OR.

Show Outline:

Scheduled Indications – Repeat cesarean, hx of uterine surgery, abnormal placentation (placenta previa, vasa previa, accreta, etc.), malpresentation (not cephalic), multiple gestation

In-Labor Indications – Arrest of dilation, arrest of descent, nonreassuring fetal heart tones, elective

Anatomy – Layers of the anterior abdominal wall: skin, subcutaneous tissue, superficial fascia (Camper's, Scarpa's), external oblique, internal oblique, transversus abdominis, transversalis fascia, preperitoneal tissue, and peritoneum

Key Surgical Steps

Clear surgical field and adhesions, bladder flap

Hysterotomy in the lower uterine segment (avoid lateral uterine vessels)

Deliver baby with delayed cord clamping, deliver placenta

Manage atony with same meds as vaginal delivery

Possibly exteriorize uterus to see better – depends on scarring

How to Be Helpful – Visualization! Bladder blade, suction, and clean with laps between sutures

Closure

Two-layer hysterotomy if future labor desired

Peritoneum – optional, no evidence either way

Muscle – do NOT close (risk of hematoma)

Fascia – close! Key nerves: ilioinguinal, iliohypogastric

Subcutaneous fat – close if >2cm depth

Skin – staples, suture, or absorbable staples

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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By Jennifer Doorey, MD, MS

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