The steps of the Cesarean section : the do's and the don't's / by Howard A. Kelly.

  • Kelly, Howard A. (Howard Atwood), 1858-1943.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The steps of the Cesarean section : the do's and the don't's / by Howard A. Kelly. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    13/16 (page 13)
    ized and discharged through the abdominal wall, thereby sav- ing the patient. XXf. Closure of the Abdominal Incision.—Finally the abdominal cavity is closed by ten or twelve silk sutures, about twelve millimetres apart, embracingall the layers. Between each of these deep sutures superficial sutures should be passed wherever the approximation is not perfect. THE SUBSEQUENT CARE OF THE CASE. An accurate record of pulse, temperature, and amount q£ urine passed and amount of sleep should be kept. Immediately after the operation separate the labia, wipe out the vaginal outlet, and throw in three to four drachms of the iodoform and boric acid powder (1 to 7); this keeps the dis- charges sweet at the only point at which they are in contact with the air. Every time the nurse draws the urine she first wipes off the orifice of the urethra with a piece of absorbent cotton and throws a drachm of the powder into the vulvar orifice. A pad of absorbent cotton is kept loosely applied to the vulva by a T-bandage, and changed as often as soiled, or every three hours at first. There is no reason why the baby should not nurse the day after the delivery—in from twelve to twenty-four hours. The abdominal sutures should all be removed on the eighth day, and a firm abdominal binder applied. It is always a matter of interest, after emptying the uterus, to note where the lower segment is sharply defined by the formation of the prominent shelf-like contraction ring. Before closing the abdomen measure the conjugata vera. ERRORS TO BE AVOIDED. I. Do not use antiseptic solutions for instruments or hands after the operation has begun; above all, do not use them in the abdominal cavity. Use pure water throughout, prefer- ably distilled, which has been boiled a half-hour. II. Do not turn the uterus out of the abdomen before de- livering the child, unless its contents are doubtfully septic; it does no good, adding an unnecessary step and calling for a larger abdominal incision.