1. Cut the abdomen

2. Cut the amniotic membrane

3. Leave the baby’s head out of the mother’s body

4. Remove the shoulders The mother's body can be seen with the umbilical cord wrapped around her neck

5. The baby is completely separated

6. Suturing and disinfecting the broken end of the baby's umbilical cord

7. Suturing Amniotic membrane and abdomen and disinfection

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1. The methods of incision of the abdominal wall include midline longitudinal incision, paramidline longitudinal incision and superior transverse incision on the pubic symphysis (Figure 1). The size of the incision should be based on the principle of fully exposing the lower uterine segment and successfully delivering the fetus.

2. Exploring the abdominal cavity to detect the direction and degree of uterine rotation, the formation of the lower segment, the size of the fetal head, and the height of presentation, in order to estimate the location and size of the uterine incision, the difficulty and preparation of the operation, and take appropriate measures for exploration. Then, saline gauze pads are filled between both sides of the uterus and the abdominal wall to push open the intestines and prevent amniotic fluid and blood from entering the abdominal cavity.

3. Cut the reflexed peritoneum of the bladder. Use forceps to lift the reflexed peritoneum 2cm away from the reflexed peritoneum of the uterus and bladder. Cut a small opening horizontally and extend it in an arc to 10-12cm on both sides (Figure 2). Each side reaches the medial side of the round ligament.

4. Separate and push down the bladder. Use rat-tooth forceps to lift the free edge of the folded peritoneal incision in the lower segment of the uterus near the bladder side. The operator bluntly separates the posterior wall of the bladder from the lower segment of the uterus with the left index and middle fingers. Push downward (Figure 3) to fully expose the lower uterine segment. If there are obvious blood vessels behind the bladder, the anterior cervical fascia can be cut open and pushed away from the bladder under the fascia to reduce bleeding.

5. Incision of the uterus

⑴ Conventional transverse incision in the lower segment of the uterus: the height of the incision is determined according to the position of the fetal head, generally at the level of the largest diameter line of the fetal head, that is, the most bulging lower segment Suitable for every situation. ① If the fetal head is deeply embedded, it should be lowered, and the lowest distance from the bladder boundary should not be shorter than 2cm. ② For those with high-floating fetal head, it is appropriate to place the incision 2cm below the junction between the lower segment and the uterine body. If the incision is made at the junction, the thickness of the uterine wall will vary greatly, making suturing difficult and affecting healing. Make a 2-3cm transverse incision in the middle of the lower uterus (Figure 4), then use both hands to bluntly tear open and extend the incision on the left and right sides (Figure 5). When the resistance is high, do not use violence and use uterine scissors instead. Cut it open, and use uterine scissors under the guidance of the left posterior indicator to cut upward in an arc on both sides under direct vision (Figure 6). The length of the incision is 10-12cm, and try to avoid puncturing the amniotic sac.

⑵Longitudinal incision in the lower uterine segment: It is suitable for women whose lower segment has been fully expanded, has varicose veins on both sides, or whose fetal head has been deeply embedded in the pelvic cavity. Make a 2-3cm longitudinal incision in the middle of the lower uterus to ensure that the amniotic sac is intact. Use the middle two fingers of your left hand to guide under the incision. Hold the uterine scissors in your right hand and cut downward to 2cm away from the free edge of the bladder to avoid damaging the bladder when delivering the fetal head. , cut the lower segment upward in the same way, and if the incision is not large enough and extend toward the body position, this surgery can only complete a long enough incision when the lower segment is fully expanded. If the lower segment is not formed enough, it can be extended toward the uterine body to become the lower segment-uterine cesarean section (Figure 7), which is rarely used at present.

6. Deliver the fetus. Use a vascular forceps to pierce the amniotic membrane, and after sucking out the amniotic fluid, enter the uterus with your right hand to explore the position and height of the presentation. If it is in the cephalic position, insert your hand into the front and bottom of the fetal head to the occiputofrontal circumferential plane, turn the delivery machine to the uterine incision, lift and rotate the fetal head, when the fetal presentation has reached the incision, use your left hand to pull the uterine incision upward. On the upper edge, the right hand holds the fetal head in an occiput-anterior position toward the outside and upper side of the uterine incision. At the same time, the assistant applies pressure to the fundus of the uterus to assist in the delivery of the fetal head (Figure 8). Immediately after the fetal head is delivered, squeeze out the liquid in the fetal mouth and nasal cavity with your hands, or use a rubber ball and a straw to suck out the liquid in the mouth and nasal cavity (Figure 9-10), then tilt the fetal neck to one side and hold it with both hands. After the fetal mandible is pulled to deliver one shoulder, pull to the opposite side. After both shoulders are delivered, immediately pull outward to pull out the fetal body (Figure 11 to Figure 13). After the umbilical cord is cut, the newborn is handed over to the table for treatment.