Caesarean Section: Step 5 - Closure of Uterus

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 are going to close the uterine incision

The uterine incision, the first thing would be to identify the angle

because that's where the most risk of bleeding occurs

so we should be sure that we have identified and start our sutering from the angle of the uterine incision

and we are going to use usually vciril or chromic cat gut can also be use

the stitch is going to be continuous

suturing, after we grasp, make sure we have got the angle we'll go by doing continuous suturing

and sometimes if we are doing, if we are having heavy bleeding, we can use locking sutures

but if we feel the bleeding is controlled we don't have to lock the sutures

while the surgeon is doing this continuous suturing, the assistant's role is a big role here

holding the uterus still, preferably by

using a pack

and also holding the suture also

by following the surgeon and hold the suture tight

and once we have done

in this video, you'll see that the surgeon is going to close the uterine incision

in one layer

and now there are two schools of thoughts about the uterine closure

either it could be closed in one layer or two layers

some studies have shown that using one layer closure decreases operation time

with still the same kind of results

still some would argue that the risk of bleeding and risk of future infection

and disheasance would increase with one layer

both ways are acceptable

but usually in our practice, in our set up what we practice is using two layer approach

so we are finish putting suture with one layer, then we are repeat the same procedure and close uterine incision in two layers

and nowadays, we have abundant closing peritonium, even after the

this is because it heals by iteslf quickly

and so by not closing it it decreases postoperative pain and so it is preferred to not close the xxx

once we are done with the closure of the uterine incision in two layers we have to make sure we don't have any bleeding

don't leave any bleaders

if there are any bleeding we have to do hemostatic sutures

in those areas where we see bleeding

we have to make sure we are controlled

all the bleeding sites

you can see now there are two bleeders

that the surgeon is going to control using hemostatic sutures

So once we are sure the bleeding has been controlled, we don't have any other procedure like tubal ligation

we'll just return the uterus to the abdominal cavity