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.
Scheduled Indications – Repeat cesarean, hx of uterine surgery, abnormal placentation (placenta previa, vasa previa, accreta, etc.), malpresentation (not cephalic), multiple gestationIn-Labor Indications – Arrest of dilation, arrest of descent, nonreassuring fetal heart tones, electiveAnatomy – 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 peritoneumKey Surgical StepsClear surgical field and adhesions, bladder flapHysterotomy in the lower uterine segment (avoid lateral uterine vessels)Deliver baby with delayed cord clamping, deliver placentaManage atony with same meds as vaginal deliveryPossibly exteriorize uterus to see better – depends on scarringHow to Be Helpful – Visualization! Bladder blade, suction, and clean with laps between suturesClosureTwo-layer hysterotomy if future labor desiredPeritoneum – optional, no evidence either wayMuscle – do NOT close (risk of hematoma)Fascia – close! Key nerves: ilioinguinal, iliohypogastricSubcutaneous fat – close if >2cm depthSkin – staples, suture, or absorbable staplesJennifer 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.