Managing Complications in Pregnancy and Childbirth: - IAWG

Caesarean sectionP-45• Use two fingers to push the bladder downwards off of the loweruterine segment. Replace the bladder retractor over the pubic boneand bladder.OPENING THE UTERUS• Use a scalpel to make a 3 cm transverse incision in the lowersegment of the uterus. It should be about 1 cm below the levelwhere the vesico-uterine serosa was incised to bring the bladderdown.• Widen the incision by placing a finger at each edge and gentlypulling upwards and laterally at the same time (Fig P-20).• If the lower uterine segment is thick and narrow, extend theincision in a crescent shape, using scissors instead of fingers toavoid extension of the uterine vessels.It is important to make the uterine incision big enough to deliver thehead and body of the baby without tearing the incision.FIGURE P-20Enlarging the uterine incisionDELIVERY OF THE BABY AND PLACENTA• To deliver the baby, place one hand inside the uterine cavitybetween the uterus and the baby’s head.• With the fingers, grasp and flex the head.• Gently lift the baby’s head through the incision (Fig P-21, pageP-46), taking care not to extend the incision down towards thecervix.