D&C

Dilation of the Cervix and Curettage of the Uterus

Definition:
Definition of the cervix and scraping away the uterine mucose.

Position:
Lithotomy.

Instrument:
- Sponge holding forceps.
- Vaginal speculum (Auvard - Sim).
- Uterine dilators (Hegar)
- Uterine curette (Sims).
- Bladder uretheral. Sound
- Endometrial biopsy curette.
- Uterine dressing forceps.
- Female catheter metal.
- Towel clips (4)

Outline of Procedure:-
An Auvard's speculum is inserted and the cervix drawn down and steadied with
one or two vulsellum forcepe .The position and length of the uterus are gauged
with a uterine sound and progressively Jarger size of uterine dilators are inserted
until the OS is large enough to introduce the curette .

The surgeon always holds each ditator between his thumb and for finger with the
other fingers extended at the side, so that should the dilator slip, these extended
fingers will come into contact with the buttocks and prevent the dilator
penetrating too deeply and perforating the uterus .

A uterine curette is inserted and the mucose scraped gently and systematically .
The curetted mucose is sent for histological examination.

Who needs a D & C ?

D&C may be required to diagnosed and/or treat

Complication:
1. Infection
2. Bleeding
3. Perforation of uterus
4. Fistula
5. Hysterectomy
 Caesarean section C.S

Caesarean Delivery

Definition:-
Removal of the fetus through an incision in the Abdominal wall and uterus .

Position:
Supins, followed thy trendelen burg 10 - 20

Instrument:
- Laparotomy set
- Armytage
- Doyan retractor
- Suction tube

Suture required:-
- Chromic catgut 2
- Chromic catgut 1
- Vicryle 1 or 0
- Silk 2/0 or 0 cutting needle, for skin sutures.

Anesthesia:
Spinal or epidural anesthetic or may be G.A general Anesthesia.

Incision used for caesarean section:

In caesarean section the doctor make an incision usually it is horizontal incision
made low A cross the belly, just above the pubic hair line... This navel down to the
pubic area.
 Types of Cesarean Section

There are four types of cesarean section

Caesarean section Caesarean section Emergency Selective

After dead of Fetus (not emergency) Caesarean caesarean
section section

Causes of Caesarean Section:

There are many cause but divided into

Causes find in the

Mother uterus Placenta fetus Amniotic fluid

1) Causes are found in mother:

1. Depended the age of the mother, especially hymen women, where it loose
stretch of smooth muscle in vaginal delivery.
2. If the mother is affected by high blood pressure of other illness such as
Kidneys, diabetes.
3. In case of eclampsia.
4. If the hand of fetus appear through vagina
 2) Cause are found in placenta:-
(placenta praevia) (low lying placenta)

placenta are found in the lower segment of uterus and divided in to four types of
placenta praevia:-

1. centrails
2. Lateralis.
3. Marginalis
4. Low lying placenta.

3) Causes are found in the fetus:-

1. Length time of pregnancy (more than 42 weeks).
2. Increase weight or overweight of the baby (if its more than 4kg of Increase
size of head of the baby.
3. Increase number of babg's if-has had more than two baby called twins
especially if the first baby come the head upwards.
4. if the baby is lying with its head up wards (breech baby).
5. if the unborn baby is to small or to weak-to-survive anatural birth.

4) Causes are found in uterus:-

1. operation in the uterus
2. contraction of the uterus
3. cause in cervix of uterus

I. operation in the uterus:-

A. if the mother has had a privous caesarean section
B. If the mother done removal fibroid tumor from the uterus.
C. If the mother done operation to repair congenital Anematis in the uterus
II. contraction of uterus:-
A. Irregular contraction of uterus
B. Weak contraction of uterus

III. cause in cervix of uterus:-

 A. Don't dilated cervix of the uterus

Causes in Amniotic fluid:-

A. Increase amount of the Amniotic fluid that threaten the baby life.
B. less Amount of the Amniotic fluid that threaten the baby life.

Ont line:
1. A transverse's or horizontally Incision is made just Above the public line.
2. Horizontally incision is made in the uterus after separating the bladder
from the uterus
3. The Incision's complete with scissors and by manual stretching
4. The fetus is delivered and the umbilical cord clamped with forceps and
divided.
5. The midwife or peadatrician resuscitate the child
6. Placenta is delivered and cut edges of the uterus grasped with Armytage
forceps.
7. Suction is used to remove Amniotic fluid
8. The incision in the uterus is closed with two layers of chromic catgut
9. The wound is closed in usual manner.

Complication of caesarean section:

1. Bleeding after caesarean section.
2. Caesarean scar.
3. Infection after caesarean section.
4. Nerve injury after caesarean section.
5. Medication risk and caesarean section.
6. Uterine rupture after caesarean section.
7. Bladder injury following a caesarean section.
8. Organs injury with caesarean section.
9. Adhesions and caesarean section.
10.blood clot following a caesarean section
11.D.V.T Deep vein thrombosis.
12.Delayed bowel function following a caesarean section.
13.U.T.I urinary tract infection