Lower Segment Caesarean Section

PROCEDURE

1. PATIENT PUT IN SUPINE POSITION.
2. ABDOMEN CLEANED AND DRAPED.
3. PFANNESTIAL INCISION MADE AND ABDOMEN OPENED IN LAYERS
4. UV FOLD IDENTIFIED AND SEPARATED
5. BLADDER PUSHED AWAY CAUDALLY AND RETRACTED INFERIORLY WITH DOYAN’S RETRACTOR.
6. TRANSVERSE INCISION MADE AT LOWER SEGMENT OF UTERUS.
7. INCISION EXTENDED WITH BLUNT DISSECTION
8. AMNIOTOMY DONE AND BABY DELIVERED
9. PLACENTA AND MEMBRANES DELIVERED VIA CCT.
10. UTERUS CLOSED IN 2 LAYERS WITH VICRYL 1-0
11. FALLOPIAN TUBES AND OVARIES NORMAL
12. HAEMOSTASIS SECURED.
13. SWAB AND INSTRUMENT COUNTS WERE CORRECT.
14. RECTUS SHEATH WAS CLOSED WITH VICRYL 1.
15. SKIN WAS CLOSED VICRYL 2-0.
16. VAGINAL TOILET DONE AND BLOOD CLOTS EVACUATED.

POST OPERATIVE MANAGEMENT

1. TRANSFER OUT TO WARD ONCE PATIENT STABLE.
2. ALLOW ORALLY
3. LIE IN SUPINE POSITION FOR 6 HOURS (SPINAL)
4. BP/ PR MONITORING 1/4HOURLY UNTIL STABLE
5. CBD FOR ONE DAY
6. STRICT PAD CHARTING.
7. IVD 5 PINTS OF NSD5% / 24 H UNTIL PATIENT TAKING ORALLY WELL
8. CONTINUE ANALGESIA AS ORDERED BY ANESTHETIST. EG: SERVE SUP VOLTAREN 75MG BD. START FIRST DOSE 6 HOURS POST OP
9. SC HEPARIN 5000U BD TILL AMBULATING WELL
10. IV CEFOBID 1G BD + IV METRONIDAZSOLE 500MG TDS X 24 HOURS
11. WI DAY 2.
12. STO NOT REQUIRED
13. MODE OF DELIVERY NEXT PREGNANCY: TOS/LSCS
14. FBC DAY 2
15. IV PITOCIN 40U FOR 6H

Post Caesarian-section REVIEW

Age/race Para 1, Post ELLSCS 2 hours for breech presentation 

ANC: Breech presentation with oligohydromnios 

Intra operative findings: from op notes 

Progress: 
Patient complains of minimal pain at the op site 
Otherwise: No dizziness/headache, No SOB/chest pain No palpitations, No calf tenderness 

Unable to move legs, sensations intact 
Urine output: 400cc from the OT 
Pad: 3/4 soaked since from the OT 

Clinical: 
alert and conscious, pink, hydration fair 
not tachypneic, not tachycardic, vitals stable and afebrile 

Lungs: clear with equal air entry bilaterally 
CVS: DRNM 
PA: soft with minimal tenderness at the op site uterus well contracted at 20 weeks dressing minimally soaked 

Plan: To continue post op plan  

credit to : Ampang HO guide

Click to access ogobook1.pdf