Performance of a cesarean section
- The abdominal cavity is accessed with a suprasymphyseal transverse (Pfannenstiel or Joel-Cohen) incision. The abdominal wall is separated with alternating incisions.
- If the fetus is mature, the uterotomy is always carried out on the lower uterus. The visceral peritoneum of the bladder is opened beforehand, and the bladder itself is separated from the lower part of the uterus. In case of a pregnancy at term, the lower part of the uterus is thinned and contains few contractile filaments. Therefore, access through this part is preferred.
In contrast to this approach, a vertical incision is usually used for uterotomy in preterm cesarean sections. This incision allows for a large enough opening to deliver the baby, which is especially important in case of oligohydramnios, very small fetus, or malpresentation of the fetus.
- The fetus is delivered after the amniotic sac has been opened.
- Uterotonic agents (e.g. oxytocin) are used to support contraction of the uterus.
- The placenta is manually removed. The uterine cavity is checked for remaining parts of the placenta.
- Uterus and abdominal are sutured and closed.
For emergency cesarean sections, after the decision to perform emergent cesarean section has been made, the fetus should be delivered within 20 minutes.