Before Your First: Cesarean Section

Whether it's scheduled or called urgently during labor, the cesarean section is one of the most common surgeries you'll see on Ob/Gyn. This episode covers the indications, abdominal wall anatomy layer by layer, the key surgical steps from hysterotomy to closure, and how you can be the most helpful in the OR.

Show Outline:

• Scheduled Indications – Repeat cesarean, hx of uterine surgery, abnormal placentation (placenta previa, vasa previa, accreta, etc.), malpresentation (not cephalic), multiple gestation
• In-Labor Indications – Arrest of dilation, arrest of descent, nonreassuring fetal heart tones, elective
• Anatomy – Layers of the anterior abdominal wall: skin, subcutaneous tissue, superficial fascia (Camper's, Scarpa's), external oblique, internal oblique, transversus abdominis, transversalis fascia, preperitoneal tissue, and peritoneum
• Key Surgical Steps
  • Clear surgical field and adhesions, bladder flap
  • Hysterotomy in the lower uterine segment (avoid lateral uterine vessels)
  • Deliver baby with delayed cord clamping, deliver placenta
  • Manage atony with same meds as vaginal delivery
  • Possibly exteriorize uterus to see better – depends on scarring
• How to Be Helpful – Visualization! Bladder blade, suction, and clean with laps between sutures
• Closure
  • Two-layer hysterotomy if future labor desired
  • Peritoneum – optional, no evidence either way
  • Muscle – do NOT close (risk of hematoma)
  • Fascia – close! Key nerves: ilioinguinal, iliohypogastric
  • Subcutaneous fat – close if >2cm depth
  • Skin – staples, suture, or absorbable staples

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.