CC Chua, Prince Robert C.

November 27, 2020

Group 2-A

Reflection Paper 4C

Peripartum cesarean section hysterectomy is done at the time or within 24 hours of delivery.
Cesarean hysterectomy can be classified as emergent, indicated non-emergent, or for elective
sterilization. Emergency cases would be due to uterine hemorrhage, placental problems, or infection.
The most common indication for emergency procedures is severe uterine hemorrhage that cannot be
controlled by conservative measures. The video started by showing engorged vascularities which is also
known as “bag of worms”. A high classical cesarean section incision was performed. The baby was
delivered feet first and the fetal head was delivered last. It appears that there was not enough care in
handling the fetal head. There could be damage to the fetal head or nerves if there was mishandling of
the fetal head. The round ligament was cut and suture was ligated. The utero-ovarian ligament was cut
and ligated along with the fallopian tube at the utero-tubal junction. The bladder was distended and the
vesico-uterine fold was lowered. The uterine arteries were cut and suture ligated. The feeding vessel
from anterior lower uterine segment to posterior wall of the bladder was cut and ligated. Incision was
then performed in the vaginal canal. The vaginal cuff was closed. The rest of the video shows the gross
view of the uterus. The video was able to explain each step in the procedure. I appreciate the details in
the explanations of every step of the procedure. The parts of the gross view of the uterus were properly
labeled. The procedure was done smoothly and quickly by the team. The team members know their role
in the procedure and were able to effectively perform their individual tasks. It would be better if the
equipment used in each step was mentioned in the video. There was no mention of the names of the
equipment used in the procedure. The camera was able to show the entire procedure clearly. The video
was also able to show the indication of the cesarean section hysterectomy. The engorged veins were
properly visualized before and after removal of the uterus. The clamping of ligaments was done properly
and demonstrated in the video clearly. However, the proper close of the surgical site was not
demonstrated in the video. I learned that it is important to clamp all the necessary blood supply
involved in the uterus prior to cutting out the uterus. This is to prevent bleeding of the patient. I also
learned that proper teamwork is necessary in doing surgical procedures. As demonstrated in the video, a
lot of the steps in the procedure are done by members of the team. A single operator cannot perform
the procedure alone. It is vital to procedures such as this the importance of knowing one’s
responsibilities and communicating properly with team members.