0:00:00.000,0:00:03.229
The next step is to deliver the fetus

0:00:03.306,0:00:07.804
where we would insert our hand below the head

0:00:07.804,0:00:10.483
and we remove the retractor

0:00:10.514,0:00:13.801
and as soon as the head is delivered

0:00:13.846,0:00:17.006
before the delivery of the shoulder

0:00:17.006,0:00:20.568
we would be first suctioning the mouth

0:00:20.698,0:00:22.969
followed by the nostrils

0:00:24.400,0:00:24.400
suctioning the mouth first would decrease the risk of aspiration

0:00:24.400,0:00:24.401
and then we would deliver the whole baby

0:00:24.401,0:00:26.636
and continue with the suction

0:00:26.636,0:00:31.184
while we are clamping the cord

0:00:31.184,0:00:32.908
the chord would be clamped

0:00:32.908,0:00:35.688
at two points

0:00:35.688,0:00:44.865
and would be cut by the assistant and the baby would be

0:00:44.865,0:00:47.116
taken to continuing resusitation

0:00:47.116,0:00:49.705
the next step now is to deliver the placenta

0:00:49.705,0:00:56.463
theh placenta can be delivered by manual removal or controlled contraction

0:00:56.463,0:01:02.302
the risk of bleeding and the risk of infection is found to be higher in removing it by manually

0:01:02.302,0:01:04.942
so the preferable way is to remove it by controlled contraction, as you can see here

0:01:04.942,0:01:13.732
also when the baby is being deivered

0:01:13.732,0:01:18.402
we should give oxytocin to the mother

0:01:18.402,0:01:26.576
and also during the delivery of the fetus also to give prophylactic antibiotics

0:01:26.576,0:01:33.403
once we deliver the placenta

0:01:33.403,0:01:39.339
it is always good to mop the inside of the uterine cavity

0:01:39.339,0:01:45.381
to be sure we have not left any fragments of placenta or membranes

0:01:45.381,0:01:57.106
and then we'll exteriorize the uterus to, both for easy visualization of the repair and also to see any bleeding,

0:01:57.106,0:02:03.735
we should insert the X retractor at this point and we should look for any bleeders

0:02:03.735,0:02:11.908
and this is where we are going to use a green armitage that you can see here holding, the surgeon holding

0:02:11.908,0:02:17.129
and the green armitage is specific used for cesarean section because it is a clamp that can bring hemostasis without crushing the uterine wall

0:02:17.129,0:02:27.388
all the bleeders would be clamped by the green armitage before we start

0:02:27.388,0:02:29.975
the closure, closing the uterine incision

0:02:29.975,0:02:33.144
This is the stage where we are going to dilate the cervix

0:02:33.144,0:02:40.150
so we have good drainage

0:02:40.150,0:02:44.150
using either fingers or sponge x