Caesarean Section: Step 6 - Closure of Abdomen

This is part of a series of surgical videos for training on Caesarean Section. Viewer discretion is advised: The educational material contained herein may contain medical images that non-professional viewers may find disturbing. The full learning module is available at: http://open.umich.edu/education/med/oernetwork/med/ob-gyn/caesarean-adaptation/2012. The narration is by Dr. Lia Tadesse (St. Paul Hospital Millennium Medical College) in Ethiopia, the procedure is demonstrated by Dr. Richard Adanu (University of Ghana), and the recording was done by Dr. Cary Engleberg (University of Michigan). Along with other resources in the module, this video is shared under a Creative Commons Attribution Noncommercial 3.0 License: http://www.creativecommons.org/licenses/by-nc/3.0/. Video recorded by Dr. Cary Engleberg (University of Michigan). This video is provided by the African Health OER Network (http://www.oerafrica.org/healthoer). Video transcribed by Kathleen Omollo (University of Michigan).

Now we have reached the stage of closing the abdomen

we don't close the p pereotneum

which heals by itself in a few days

in some cases you will see that some surgeons will approximate the rectus abdominus muscle

but that not also necessary

as you can see now the first step of closing the abdomen is closing the rectus sheath

so the rectus sheath or the fascia will be closed by usually

Vicryl

and the first step would be to start from the angles and we are going to suture

it in a continuous nonlocking sutures

and when we are closing the fascia is to make sure is that

the firstly that the knot we use at the first site where we are going to do the knot at the angle should be

locked very well, and the knot should be tight and locked at least four to five times

and then when we are doing the continuous suture we should at least in each margin

go inside 1.5 cm inside the rectus sheath so that we avoid any risk

of tearing of the surture and subsequent dehiscence of the wound

so we should make sure we should grasp enough of the rectus sheathh at least 1.5 cm from the margin of the wound

while we are doing the continuous suture

so once we reach the other end of the wound we should make sure just like we did

at the closure of the facia at the first end

we should make sure the knot is strong and the knot is repeated at least four or five times

and then the next step after we are finished with this

we should make sure there are no bleeders inside the subcutaneous fat

and occasionally if it is a very deep subcutaneous fat we may do a some

interrupted stitch in the subcutaneous fat to avoid a big dead space that could result in subsequent infection

but if it is not a deep one then we don't need to put any stitches in the subcutaneous fat

and then in the final stage of the procedure

is closing the skin

so the skin would be usually closed by a

subcuticular stitch that you can see now

using a 2 O or a 3 O stitch

it will be a subcuticular continuous stitch that we are going to apply

So after we are done with the closure of the skin

before we dress the wound we have to clean it

again with some povodone iodine then we put a sterile dressing

and tape the wound

and after we are done with this

we also have to check and clean the vagina

of the woman for any clots, accumulating clots

so we'd have to do this with assistance