Question

1. List five reasons for performing a cesarean section and state the most frequent reason for this procedure.

2. What steps performed in a traditional vaginal hysterectomy may be performed laparoscopically? What is the advantage of the laparoscopic approach?

3. Define and list the basic steps in a Pfannenstiel abdominal incision.

4. List the structures that will be removed during a total pelvic exenteration.

5. Name at least two medications that may be used to treat uterine hemorrhage following childbirth.

6. Briefly describe how the sequence of events for an emergency cesarean section (e.g., prolapsed umbilical cord, placenta abruption) may differ from a planned cesarean section.

Answer 1

Answer q 1

Cesarean section is an operative procedure done under anaesthesia ,in this procedure an incision is given to the abdominal wall and the uterus , through which the fetus ,placenta and membranes are delivered.. There are mainly two type of cesarean section Elective cesarean section and Emergency cesarean section

Reason for performing cesarean section

- Breech presentation

- certain fetal abnormalities like hydrocephalus

- Antepartum haemorrhage  

-Cephalopelvic disproportion

- major degree of placenta praevia

The most frequent reason for the cesarean section is when there is inadequate dilatation of the cervix and there is no progress in the labour over several hours .This may leads to fetal distress an immediate cesarean section is required for this condition .

Answer q 3

In cesarean section the incision is mainly given in to the lower uterine segment ,because the lower uterine segment is less muscular and active part of the uterus and can heals better . Pfannensteil incision is also known as Bikini line incision .

Step of pfannensteil abdominal incision

The anatomical layers which are incised is

-skin

-fat

-rectus sheath

-muscle (rectus abdominis)

-abdominal peritoneum

-pelvic peritoneum

-uterine muscle

The first transverse incision is given to the skin , the subcutaneous tissue is incised only a small portion and the lateral tissues are separated manually The rectus sheath is separated with a knife then the abdominal peritoneum separated blundly with the two fingers .Once the abdominal cavity is opened the loose folds of the peritoneum over the anterior aspect of the lower uterine segment and above the bladder is incised . The fundus of the bladder pushed down and away from the surgeon to prevent giving cut in to the bladder ,The uterus is incised transversely and the surgeon direct the fetal head out while the assistant give fundal pressure to help the delivery of the baby . once the baby deliverd clamp the cord and cut . after the delivery of the baby and placenta the uterus is sutured. The uterus sutured in two layers ,then the peritoneum is closed then the rectus sheath , fat and at last the skin is sutured .

Answer q 4

pelvic exenteration is done if the cancer has spread it includes the surgical removal of all organs from the pelvic cavity . The pelvic organs includes

-Uterus

- fallopian tubes

-ovaries

-urinary bladder

-vagina

-rectum

-colon

If a person under gone a total pelvic exenteration required permanent colostomy and urinary diversion

-

Answer q 5

post partum haemorrhage is one of the major complication in the third stage of labour or within 24 hours after the labour The first choice of medication to control bleeding is Oxytocin 5 unit or 10 units

-inj .prostaglandin - it is used in case of uterine atony 250mcg IM