Managing Complications in Pregnancy and Childbirth: - IAWG

P-52 Caesarean section- The incision should be approximately 12–15 cm in length andthe lower limit should not extend to the utero-vesical fold ofthe peritoneum.• Ask an assistant (wearing high-level disinfected gloves) to applypressure on the cut edges to control the bleeding.• Cut down to the level of the membranes and then extend theincision using scissors.• After rupturing the membranes, grasp the baby’s foot and deliverthe baby.• Deliver the placenta and membranes.• Grasp the edges of the incision with Allis or Green Armytageforceps.• Close the incision using at least three layers of suture:- Close the first layer closest to the cavity but avoiding thedecidua with a continuous 0 chromic catgut (or polyglycolic)suture;- Close the second layer of uterine muscle using interrupted 1chromic catgut (or polyglycolic) sutures;- Close the superficial fibres and the serosa using a continuous0 chromic catgut (or polyglycolic) suture with an atraumaticneedle.• Close the abdomen as for lower segment caesarean section (pageP-48).The woman should not labour with future pregnancies.TUBAL LIGATION AT CAESAREANTubal ligation can be done immediately following caesarean section ifthe woman requested the procedure before labour began (duringprenatal visits). Adequate counselling and informed decision-makingand consent must precede voluntary sterilization procedures; this isoften not possible during labour and delivery.• Review for consent of patient.