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intra-operative haemorrhage

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37 - Peri-and postmortem caesarean section
from Section 8 - Management ofAnticipated and Non-anticipated Emergencies
- By Priyantha Kandanearachchi, Edwin Chandraharan
Edited by Edwin Chandraharan, Sabaratnam Arulkumaran
Book:

Obstetric and Intrapartum Emergencies

Published online:

05 November 2012

Print publication:

11 October 2012, pp 256-259
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Summary

Depending on the urgency, caesarean sections (CS) are categorised as: grade 1, grade 2, grade 3 and grade 4. Grades 1-3 are all types of emergency CS with differing degrees of urgency. Regional anaesthesia is appropriate for the majority of cases but general anaesthesia may be needed in a grade 1 CS. Lower segment transverse incision is the commonest incision used and is associated with the lowest intra-operative haemorrhage as the lower segment is thin at this level. Classical incision is a rarely used vertical incision in the upper segment of the uterus. Vicryl no.1 on a blunt needle for uterine closure and Vicryl no.1 on a sharp needle for rectus sheath are commonly used sutures. Manual separation of the placenta before spontaneous separation increases the blood loss during CS and also the risk of postoperative endometritis.