Managing Complications in Pregnancy and Childbirth: - IAWG

Caesarean sectionP-47• Hand the baby to the assistant for initial care (page C-76).• Give a single dose of prophylactic antibiotics after the cord isclamped and cut (page C-35):- ampicillin 2 g IV;- OR cefazolin 1 g IV.• Keep gentle traction on the cord and massage (rub) the uterusthrough the abdomen.• Deliver the placenta and membranes.CLOSING THE UTERINE INCISIONNote: If a Couvelaire uterus (swollen and discolored by blood) isseen at caesarean section, close it in the normal manner andobserve.• Grasp the corners of the uterine incision with clamps.• Grasp the bottom edge of the incision with clamps. Make sure it isseparate from the bladder.• Look carefully for any extensions of the uterine incision.• Repair the incision and any extensions with a continuous lockingstitch of 0 chromic catgut (or polyglycolic) suture (Fig P-23).• If there is any further bleeding from the incision site, close withfigure-of-eight sutures. There is no need for a routine second layerof sutures in the uterine incision.FIGURE P-23Closing the uterine incision