Major proceduresFree in the app
Lower segment caesarean section
Fetal compromise, failure to progress, malpresentation, praevia, ≥2 previous CS, maternal request.
Source: NICE NG192 · RCOG Consent Advice 7Steps
- WHO checklist, catheter, antibiotics before skin incision, 15° left tilt.
- Joel-Cohen transverse skin incision ~3 cm above the symphysis.
- Open rectus sheath; separate the recti.
- Open peritoneum high, away from the bladder.
- Doyen’s retractor; incise uterovesical peritoneum, push bladder down.
- 2 cm transverse incision in lower segment, extend bluntly.
- Deliver head (hand or Wrigley’s), then body; oxytocin 5 IU slow IV.
- Delay cord clamping; placenta by controlled cord traction (not manual removal).
- Check cavity empty; Green-Armytage clamps on the angles.
- Close uterus in 2 layers (No. 1 Vicryl).
- Check haemostasis, ovaries, bladder; swab & instrument count.
- Close sheath (looped PDS/Vicryl) and skin.
Consent risks
| Hysterectomy | 7–8 per 1000 (11% with praevia; 27% with praevia + previous CS) |
|---|---|
| Bladder | 1 per 1000 |
| Ureter | 3 per 10,000 |
| Death | ~1 per 12,000 |
| Next pregnancy | Praevia 4–8 per 1000 |
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.