The next step is to deliver the fetus
where we would insert our hand below the head
and we remove the retractor
and as soon as the head is delivered
before the delivery of the shoulder
we would be first suctioning the mouth
followed by the nostrils
suctioning the mouth first would decrease the risk of aspiration
and then we would deliver the whole baby
and continue with the suction
while we are clamping the cord
the chord would be clamped
at two points
and would be cut by the assistant and the baby would be
taken to continuing resusitation
the next step now is to deliver the placenta
theh placenta can be delivered by manual removal or controlled contraction
the risk of bleeding and the risk of infection is found to be higher in removing it by manually
so the preferable way is to remove it by controlled contraction, as you can see here
also when the baby is being deivered
we should give oxytocin to the mother
and also during the delivery of the fetus also to give prophylactic antibiotics
once we deliver the placenta
it is always good to mop the inside of the uterine cavity
to be sure we have not left any fragments of placenta or membranes
and then we'll exteriorize the uterus to, both for easy visualization of the repair and also to see any bleeding,
we should insert the X retractor at this point and we should look for any bleeders
and this is where we are going to use a green armitage that you can see here holding, the surgeon holding
and the green armitage is specific used for cesarean section because it is a clamp that can bring hemostasis without crushing the uterine wall
all the bleeders would be clamped by the green armitage before we start
the closure, closing the uterine incision
This is the stage where we are going to dilate the cervix
so we have good drainage
using either fingers or sponge x