Cesarean Section (Caesarean, C-section)
The delivery of a viable fetus through abdominal and uterine incisions (in the operating room).
- The procedure takes its name from the Latin word “caedere”, to cut.
- Whether it is scheduled or emergent, it is an exciting, fast-paced, and gratifying procedure for all the members of the surgical team.
- There are numerous indications for this method of delivery, including dystocia (failure to progress), cephalopelvic disproportion; malrotation, and placenta previa. Additionally, uterine fibroids, which may block the vaginal passageway, herpes, and condylomata may also be indications for cesarean section.
- Previous C-sections are no longer single indications for this procedure unless the condition mentioned above are also present.
- Emergency C-sections are those performed because of threatening conditions to the mother and/ or the baby.
- Supine, with a small roll under the right hip (to reduce vena cava compression); arms extended on armboards.
- Classic approach, vertical (low midline).
- Extra drape sheet
- Receiving pack for baby
- C-section tray
- Delivery forceps
- Cord clamp
- Basin set
- Neonatal receiving unit
- Self-contained oxygen
- I.D bands
- Bulb syringe
- Using the appropriate incisions, consistent with the estimated size of the fetus, the abdomen is opened, the rectus muscle are separated, and the peritoneum incised (similar to an abdominal hysterectomy), exposing the distended uterus.
- Large vessels are clamped or cauterized, but usually no attempt to control hemostasis is made since it may delay delivery time ( 3-5 minutes after initial incision is ideal).
- The scrub person must be ready with suction, dry laps, and a bulb syringe.
- The bladder is retracted downward with the bladder blade of the balfour retractor and a small incision is made with the second knife and extended with a bandage scissors (blunt tip prevents injury to the baby’s head).
- The amniotic sac is entered and immediately aspirated the fluid.
- The bladder blade is removed, and the assistant will push on the patient’s upper abdomen while the surgeon simultaneously delivers the infant’s head in an upward position.
- The baby’s airways are suctioned with the bulb syringe, and the baby is completely delivered and placed upon the mother’s abdomen.
- The umbilical cord is double clamped and cut.
- The baby is wrapped in a sterile receiving blanket and transferred to the warming unit for immediate assessment and care.
- Once the bay has been safely delivered, the emergent phase of the procedure has been ended.
- Using a nonecrushing clamp, the uterine wall is grasped for traction during closure.
- The closure is performed in two layers with a heavy absorbable suture, using a continuous stitch, the second overlapping the first.
- Following closure of the uterus, the bladder flap is reperitonealized with a running suture, and the uterus is pushed back inside the pelvic cavity.
- The cavity is irrigated with warm saline, and closed in layers.
- Skin is closed with the surgeon’s preference. If a tubal ligation is to be performed, it is done prior to the abdominal closure sequence.
Perioperative Nursing Considerations
- A C-section requires an additional uterine count of sponges, sharps, and instruments prior to its closure.
- Oxytocin should be available for the anesthesiologist to administer I.V.
- Once the uterus is opened, immediate suctioning is necessary.
- A warm, portable isolette should be available to transport the infant to the newborn nursery.