classical cesarean section

Classical cesarean section, also known as position cesarean section, is currently used less or not because of its many complications. The operation is simple and quick, and the fetus can be quickly delivered in an emergency, and the rescue opportunity can be obtained. The disadvantage is that the muscle tissue of the incision is thick, the suture is often unsatisfactory, the bleeding is more, the uterine rupture rate is higher during re-pregnancy, and the incidence of postoperative adhesion is high. Treating diseases: fetal distress Indication 1. Serious adhesions in the lower uterus. 2. Lower uterine varices. 3. The lower part of the uterus is poorly formed. 4. The fetal head is deeply embedded. 5. The pelvic deformity or overhanging the abdomen makes the uterus extremely forward and cannot expose the lower uterus. 6. Central placenta previa or partial placenta previa on the anterior wall. Contraindications 1. Stillbirth: In addition to maternal bleeding, uterine mouth has not yet expanded, can not give birth to a stillbirth in a short period of time, in order to save the maternal life should be managed to make vaginal delivery, if necessary, broken tires. 2. Teratogenicity: cesarean section is generally not considered. However, if there is a disease that endangers the life of the pregnant woman, it must be terminated immediately and the vaginal can not be completed, or a few deformities such as the joint twins through the vaginal broken tires, etc., still need to take the cesarean section to take the fetus. Preoperative preparation 1. The timing of surgery Whether the timing of cesarean section surgery is appropriate is directly related to the safety of mother and baby. According to statistics, the rate of cesarean section mother and infants in emergency department is 2 to 3 times higher than that of elective surgery. Therefore, emergency cesarean section should be reduced as much as possible. In general, after the full-term pregnancy, the lower part of the uterus has formed, the uterine part is enlarged, the maternal still does not feel tired, and the fetus has no signs of hypoxia, which is the best time for surgery. 2. Preoperative preparation for elective cesarean section 1 Advance admission is required. There are clear indications for surgery during antenatal examination, or women who are likely to have cesarean section should be admitted before the expected date of delivery. 2 active treatment of complications, for those with complications, should be actively treated first, such as pregnancy-induced hypertension syndrome, should be treated when the treatment is not yet fully control when choosing a favorable time for surgery. Pregnant women with anemia should check the cause and correct anemia. Pregnant women with heart disease should have heart failure before heart failure. Active infection prevention, etc., when co-infection. 3 Actively promote the maturity of the fetus, and promote the fetal lung maturation in time if the fetus is immature and must be delivered. The elective surgery can be done under all preparations, after the start of labor, or at the time of pre-production. 3. Emergency cesarean section preparation Most of the emergency cesarean section encounter difficulties in the labor process, or the pregnancy must be terminated immediately due to sudden changes in pregnancy complications, accounting for more than half of all cesarean section, some of which were admitted earlier, and more have been treated accordingly. . If you are admitted to the emergency department, doctors should pay close attention to reviewing the medical history, doing a physical examination and necessary auxiliary examinations, fully estimating the mother and baby, and identifying the indications for surgery. 4. Specific preparations 1 Correct the general condition, according to different conditions to deal with, especially pay attention to correct maternal dehydration, electrolyte imbalance, and actively deal with fetal distress. If there is hemorrhagic shock, the blood volume should be supplemented in time. 2 blood preparation, obstetric hemorrhage is often very urgent and large, you should always be ready for blood transfusion. Those who have had bleeding before delivery should be operated at the same time as blood transfusion. Because of the need for surgery before the bleeding, they can effectively stop bleeding, so they can not wait for a long time and delay the rescue. 3 preparation of skin, according to the scope of gynecological abdominal surgery. 4 catheter. 5 Preoperative medication, for pregnant women with infection or possible infection, antibiotics should be given before surgery. For immature fetuses. Preoperative medication to promote fetal lung maturation. 6 to prepare for the rescue of infants, including tracheal intubation, umbilical vascular injection. It is best to have a neonatologist to participate in the rescue. Surgical procedure 1. Incision of the abdominal wall: the method has a midline longitudinal incision, a midline longitudinal incision and a pubic symphysis. The size of the incision should be based on the principle of adequate exposure to the lower uterus and successful delivery of the fetus. 2. Cut the uterus: Take the median longitudinal incision between the bilateral ligaments on both sides of the uterine wall 4 ~ 5cm to the front of the membrane (Figure 1), use the uterine scissors to extend the upper and lower ends to 10 ~ 12cm (Figure 2), and then puncture Fetal membrane, timely absorb the overflow of amniotic fluid. 3. Delivery of the fetus: In principle, the breech delivery is completed. The surgeon uses the right hand to enlarge the membrane and breaks into the uterine cavity to hold the fetal foot. The fetus is delivered by the hip traction (Fig. 3). 4. Delivery of placenta: fetal membrane and uterine segmental cesarean section. 5. Stitching the uterine incision: The suture of the anterior wall of the uterus depends on the thickness of the muscle layer. At present, most of the two methods are used. (1) Intermittent + continuous suture method: suture the muscle layer with a large round needle and 1-0 complex intestinal line interrupted "8", without penetrating the endometrium and serosa (Fig. 4), the second layer of continuous sutured muscle Layer (Figure 5). (2) continuous + intermittent + continuous suture method: the first layer of continuous suture of the muscle layer 2 / 3, does not penetrate the endometrium and serosa (Figure 6). The second layer of sutured the muscle layer of the suture, from the serosal surface 0.5cm into the needle, deep into the muscle layer 2/3, to the opposite side of the needle, including the first layer of sutured muscle, sewn on the first layer Between the two needles, or the "8"-shaped intermittent suture to prevent gaps between the two sutures and the formation of hematoma (Figure 7). The third layer is continuously sutured with a serrated membrane layer. At this time, the needle should be slightly deep so that the serosa completely covers the uterine incision. 6. Clean the abdominal cavity: absorb the amniotic fluid, fetus and blood in the abdominal cavity, rinse the abdominal cavity with normal saline, then remove the blocked gauze pad, correct the uterus, probe the bilateral attachment for abnormality, cover the uterus incision with the omentum Reduce adhesions, spot gauze dressings and instruments. 7. Suture the abdominal wall: Check the uterus and bilateral attachments for abnormalities and wash the abdominal cavity. After checking the instruments and dressings, the layers of the abdominal wall are layered and sutured. complication infection.