Managing Complications in Pregnancy and Childbirth: - IAWG

P-44 Caesarean sectionOPENING THE ABDOMEN• Make a midline vertical incision below the umbilicus to the pubichair, through the skin and to the level of the fascia (Fig P-19).Note: If the caesarean section is peformed under local anaesthesia,make the midline incision that is about 4 cm longer than whengeneral anaesthesia is used. A Pfannenstiel incision should not beused as it takes longer, retraction is poorer and it requires morelocal anaesthetic.FIGURE P-19Site of abdominal incision• Make a 2–3 cm vertical incision in the fascia.• Hold the fascial edge with forceps and lengthen the incision upand down using scissors.• Use fingers or scissors to separate the rectus muscles (abdominalwall muscles).• Use fingers to make an opening in the peritoneum near theumbilicus. Use scissors to lengthen the incision up and down inorder to see the entire uterus. Carefully, to prevent bladder injury,use scissors to separate layers and open the lower part of theperitoneum.• Place a bladder retractor over the pubic bone.• Use forceps to pick up the loose peritoneum covering the anteriorsurface of the lower uterine segment and incise with scissors.• Extend the incision by placing the scissors between the uterus andthe loose serosa and cutting about 3 cm on each side in atransverse fashion.