Caesarean Section: Step 4 - Delivery of the baby, placenta

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).

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