Caesarean Section: Step 2 - Abdominal Incision

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).

So as this patient has taken final anesthesia we'll first check whether she is fully anesthetized

by pinching with forceps and then go to the skin incision

where in this case it is

? a final style incision which you see is a lower transverse skin incision

with a, we also have other types of lower midline or other incisions

and this incision is done around around 3 centimeters above the symphasis pubis,

and it carving an incision in the, width of the incision will depend on the estimated xxx of the xx site

and after the skin, we'll cut through the subcutaneous fat, which after cutting in the middle we cut bluntly dissect using our fingers

and then the next step would be after the subcutaneous fat we'll go to the rectus sheath, where we'll cut

using our knives, and then to widen the rectus sheath we can either use sharp dissection using our knife by x the recus sheath by using our foceps or

using blunt dissection but it should be carving the ab x dissection to avoid bleeding

and then we'll bluntly dissect the rectus abdominus muscle

but before that, what we usually do that we don't see here is we try to cut and relieve the rectus sheath from the rectus abdominus at the midline from the median raffe

and then we'll, the next step we'll reach at the peritoneum, and we'll have to pick up the peritoneum slightly higher to avoid the bladder injury

and then after making sure that we have not clamped bowel, we'll cut with a knife

or with a scissor to cut open the peritoneum and enter into the abdominal cavity

and then we'll insert our x bladder retractor after we open the abdominal cavity