Classification of abdominal incision in cesarean section
There are two ways of abdominal incision in cesarean section: transverse incision and longitudinal incision.
1. transverse incision: mostly two fingers above pubic symphysis, transverse incision 12~ 13 cm.
2. Longitudinal incision: the lower abdomen is between the umbilicus and pubic symphysis, on one side of the midline. The longitudinal incision is about 12 cm.
Before 1980s, most hospitals used longitudinal incision for cesarean section. Later, the method of transverse incision of abdominal wall was introduced and gradually popularized in hospitals all over the country. Therefore, at present, most hospitals adopt transverse incision cesarean section. Recently, it has been suggested that longitudinal incision has certain advantages, and it has also been suggested that longitudinal incision should be used in cesarean section.
Advantages and disadvantages of two kinds of abdominal incision in cesarean section
Because of the different positions, the two incisions are different in aesthetics, pain and discomfort felt by the parturient after operation, wound healing, time from skin cutting to fetal delivery, difficulty of fetal head delivery, operating field exposed by operation, postoperative adhesion, difficulty of reoperation and so on.
Advantages of transverse cut 3
1. Because the incision position is low, it can be hidden under underwear after healing. The transverse arc of the incision conforms to the skin texture and looks beautiful, which is easy to be liked by young mothers.
2. After the transverse incision, the traction is light when lying flat, so the postoperative pain is light.
3. For pregnant women with thick abdominal wall and obesity, the incidence of diseases after transverse incision is lower than that after longitudinal incision, wound healing is better than that after longitudinal incision, and fat liquefaction is less.
Disadvantages of transverse incision
1. Surgery takes a long time and requires high anesthesia, which is more suitable for elective surgery.
2. The extension of incision is limited, and the field of vision exposed during operation is limited, so it is impossible to explore widely.
3. The time from skin incision to fetal delivery is longer than that from longitudinal incision.
4. Due to the influence of wound length, delivery of fetal head is more difficult than longitudinal cutting.
5. The postoperative adhesion of each layer incision is heavier than that of the longitudinal incision, and the reoperation is more difficult than the longitudinal incision.
Five advantages of longitudinal incision
1. The time from skin incision to fetal delivery is shorter than that from transverse incision, which is especially suitable for emergency situations, such as umbilical cord prolapse and serious abnormality of fetal heart. When the fetus needs to be delivered immediately, longitudinal incision is often used.
2. It is easy to take out the fetal head, without pressing the uterine bottom, and it is very difficult to take the head.
3. The surgical field of vision is fully exposed, and the incision can be extended according to the situation. Therefore, for those who are diagnosed as myoma, ovarian tumor or need surgical exploration before operation, longitudinal incision cesarean section should be performed.
4. The operation time is shorter than the transverse incision, and the emergency can even be carried out under local anesthesia.
5. The probability of abdominal wall tissue adhesion is low, and those who require more fertility should choose longitudinal incision.
Disadvantages of longitudinal incision
1. Abdominal wall scar is obvious and unsightly, especially for people with scar constitution.
2. It is heavier to pull up and lie down, so the parturient feels more pain.
3. There are more patients with poor wound healing than transverse incision, especially those with thick abdominal wall, which is easy to cause fat liquefaction or infection.
Experts remind: if pregnant women only need to survive 1~2 times, and pay attention to beauty or abdominal wall thickness, they can choose transverse incision, but when they want to have more children and have gynecological or surgical complications, it is more suitable to choose longitudinal incision. The emergency is decided by the doctor, and more longitudinal incisions are selected.
Five nursing points of abdominal incision after cesarean section
It takes 7 days for abdominal wounds to heal, so nursing before wound healing is particularly important.
1. The wound just after operation is covered with sterile dressing, but a small amount of bloody exudation is inevitable, which is easy to breed bacteria. Therefore, the wound should be cleaned and replaced with a new sterile dressing on the second day after operation.
2. If the dressing is contaminated by lochia, it should be replaced at any time.
3. On the 7th day after operation, the wound healed, and the dressing covered on the surface can be removed to expose the wound, and the parturient can also take a bath.
4. If it is hot in summer and easy to sweat, clean the wound in the next few days and pay attention to whether there are signs of local redness and tenderness.
5. If it is a pregnant woman with scar constitution, the wound will gradually thicken after healing and bulge on the skin surface, leading to scar hyperplasia. Generally, silica gel is applied to the wound surface from the first 10 day after operation, which can reduce scar hyperplasia.
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