Professional Documents
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simplified technique
(The Silent Knife )
• Dr Muhammad El Hennawy
• Ob/gyn specialist
• 59 Street - Rass el barr –dumyat - egypt
• www.geocities.com/mmhennawy
• www.geocities.com/abc_obgyn
• Mobile 0122503011
Definition
Local anesthesia
4 -J shaped
• Vaginal cesarean section
Sharp vs blunt uterine entry
Not enough evidence
A semilunar mark is made by the scalpel cutting
partially through the myometrium for 10 cm.
A short (3cm) cut is made in the middle of this
incision mark reaching up to but not through
the membranes.
The incision is completed by the 2 index fingers
along the incision mark.
If the lower uterine segment is very thin, injury of
the foetus can be avoided by using the handle
of the scalpel or a haemostat (an artery
forceps) to open the uterus
The short (3cm) middle incision may be enlarged by
a bandage scissors over 2 fingers introduced
into the uterus to protect the foetus.
Narrow uterine incision
• Extension of the lower uterine segment incision may
be done by:
• 1- "J" shaped or hockey-stick incision: i.e. extension
of one end of the transverse semilunar incision
upwards.
• 2- "U"- shaped or trap-door incision: i.e. extension
of both ends upwards.
• 3- An inverted T incision: i.e. cutting upwards from
the middle of the transverse incision. This is the
worst choice because of its difficult repair and poor
healing
Problem of central placenta pravia
• Anterior placenta-
•Try to find out membrane up or down, rt. Or left.
If you fail, cut placenta quickly and first remove child.
• Posterior placenta–
(Dangerous placenta of Stall-Worthy.)
To stop bleeding or oozing from lower post segment,
pack it systematically with multiple roller packs. Push first
end in cervical canal.
Remove pack after 24 hours.
• If blood or fluid is leaking through the initial dressing, do not change the dressing:
Monitor the amount of blood/fluid lost by outlining the blood stain on the dressing with a pen;
• - If bleeding increases or the blood stain covers half the dressing or more, remove the
dressing and inspect the wound. Replace with another sterile dressing.
• If the dressing comes loose, reinforce with more tape rather than removing the dressing. This
will help maintain the sterility of the dressing and reduce the risk of wound infection.