Uterine incision extensionsModule by: Tina Gao. Risk factors Arrest of the first or second stage Fetal malposition (e.g. OP, asynclitic) Macrosomia Failed forceps or vacuum delivery Chorioamnionitis Abnormal fetal heart rate Prematurity Factors cluster into the following categories of risk factors for lateral extension of a transverse uterine incision: Difficulty…

Urinary tract and bowel injury at the time of Cesarean section.Module by: Margaret Burnett. Learning objectives Minimize urinary and gastrointestinal tract injury during cesarean section Recognize unintended visceral injury intraoperatively Use best practice in repairing bladder and gastrointestinal lacerations Manage postoperative care following visceral injury Introduction Injury to the urinary…

Fortunately, visceral injuries during cesarean section are rare. Prevention is key. Maintain a high index of suspicion in cases where pelvic adhesions are likely to be present (including if your patient has had previous surgery). Inspect the surface of the bowel or bladder at the site of lysed adhesions. Enter the…

Post-op management of urinary tract injury Foley in situ for 7-10 days. Bladder lacerations typically heal well within 7 days of repair.  Monitor for symptoms and signs of hydronephrosis, renal compromise or urinoma. The patient may be discharged home with instructions to return if symptoms arise. Prophylactic antibiotics are not…

Gastrointestinal injury at the time of cesarean section is rare, approximately 1/1000 cesarean deliveries.  Most injuries are minor lacerations amenable to primary repair at the time of laparotomy Generally occur at the time of abdominal entry or lysis of adhesions.  Intraoperative diagnosis is critical. Thermal injury to the bowel or…

Ureteric injury may occur by laceration, crushing or errant suture placement. Risks include: Extension of the angles of a transverse incision Hysterectomy Deep bladder lacerations that involve the trigone Presentation: Many ureteric injuries are not appreciated at the time of cesarean section.  Postoperative fever, flank pain and abdominal distention may…

Most commonly occurs at the time of abdominal entry or with dissection of the bladder flap away from the lower uterine segment Majority are bladder dome lacerations (95%) Previous cesarean contributes by: Creating adhesions between bladder and lower uterine segment Tethering the dome of the bladder higher than expected on…