Contents
With Professor Gilles Kayem, obstetrician-gynecologist at Louis-Mourier hospital (92)
Direction the boulder
Whether the cesarean is scheduled or urgent, the pregnant woman is installed in an operating room. Some maternities accept, when the conditions are right, that the dad is present at his side. Firstly, we clean the skin of the abdomen with an antiseptic product from the bottom of the thighs to the level of the chest, with emphasis on the navel. A urinary catheter is then placed in order to continuously empty the bladder. If the mother-to-be is already on an epidural, the anesthetist adds an additional dose of anesthetic products to complete the analgesia.
Skin incision
The obstetrician can now perform the cesarean section. In the past, a vertical subumbilical midline incision was made on the skin and on the uterus. This caused a lot of bleeding and the uterine scar during the next pregnancy was more fragile. Today, the skin and the uterus are generally incised transversely.. This is the so-called Pfannenstiel incision. This technique ensures more solidity. Many mothers worry about having too big a scar. This is understandable. But if the incision is too narrow, extracting the child may be more difficult. What matters is to cut the skin in the right place. The classic recommended width is 12 to 14 cm. The incision is made 2-3 cm above the pubis. The advantage? At this location, the scar is almost invisible because it is in a skin fold.
The opening of the abdominal wall
After incising the skin, the obstetrician cuts the fat and then the fascia (tissue that envelops the muscles). The technique of cesarean section has evolved in recent years under the influence of professors Joël-Cohen and Michael Stark. The fat then the muscles are spread to the fingers. The peritoneum is also opened in the same way allowing access to the abdominal cavity and the uterus. The abdominal cavity contains various organs such as the stomach, colon or bladder. This method is faster. It is necessary to count between 1 and 3 minutes to reach the peritoneal cavity during a first cesarean section. Shortening the operative time reduces bleeding and probably lowers the risk of infection, which could allow the mother to recover faster after the operation.
The opening of the uterus: hysterotomy
The doctor then accesses the uterus. The hysterotomy is performed in the lower segment where the tissue is thinnest. It is an area that bleeds little in the absence of additional pathology. In addition, the uterine scar is stronger than a suture of the body of the uterus during the next pregnancy. A forthcoming birth by natural means is thus possible. Once the uterus is incised, the gynecologist widens the incision to the fingers and ruptures the water sac. Finally, he extracts the child by the head or by the feet depending on the presentation. The baby is placed skin to skin with the mother for a few minutes. Note: if the mother has already had a cesarean section, the operation may take a little longer because there may be mating, especially between the uterus and the bladder.
Delivery
After birth, the obstetrician removes the placenta. This is the deliverance. Then, he checks that the uterine cavity is empty. The uterus is then closed. The surgeon can decide to externalize it to suture it more easily or to leave it in the abdominal cavity. Usually, the visceral peritoneum that covers the uterus and bladder is not closed. The fascia is closed. The skin of your belly is, for its part, sutured according to the practitioners, absorbable suture or not or with staples. No skin closure technique has shown a better aesthetic result six months after the operation
The technique of extra-peritoneal cesarean section In the case of an extraperitoneal cesarean section, the peritoneum is not cut. To access the uterus, the surgeon peels off the peritoneum and pushes the bladder back. By avoiding the passage through the peritoneal cavity, it would irritate the digestive system less. The main advantage of this method of cesarean section for those who offer it, is that the mother would have a faster recovery of intestinal transit. Nevertheless, this technique has not been validated by any comparative study with the classical technique. Its practice is thus very rare. Likewise, as it is more complex and time-consuming to perform, it cannot under any circumstances be practiced in an emergency. |