OG37.1 | Caesarean Section Observation — Summary & Reflection

KEY TAKEAWAYS

Caesarean section (OG37.1) is a major obstetric operation you must observe and understand. Lower-segment caesarean section (LSCS) is the standard procedure: a Pfannenstiel or Joel-Cohen skin incision, transverse lower-segment uterine incision, and layered closure. Classical CS uses a vertical upper-segment incision and is reserved for specific situations (preterm, anterior praevia, perimortem); it carries a higher scar-rupture risk and usually mandates future planned CS. The urgency categories (I–IV) determine the timeline to delivery: Category I requires delivery within 30 minutes for an immediate threat to life. Key decision points to observe: bladder flap adhesions, LUS formation, fetal extraction technique for impacted heads, uterine tone after delivery, uterine closure angles, and intraabdominal inspection. Intraoperative complications to recognise: uterine atony/PPH (most common), bladder injury (look for clear fluid), uterine incision extension (bleeding from lateral angles). Oxytocin (5 IU slow IV at delivery of fetus) is standard; carboprost is second-line but contraindicated in asthma; ergometrine is contraindicated in hypertension/pre-eclampsia. Logbook documentation of every observed CS is a NMC requirement.

REFLECT

Kolb's experiential learning cycle asks us to move from concrete experience to reflective observation, abstract conceptualisation, and active experimentation. After your observed caesarean section, take 10 minutes to answer these three questions in your journal: (1) What was the single most important decision you observed the surgeon make, and what clinical findings led to it? (2) Was there a moment in the procedure that surprised you or did not match your expectation from this module — if so, how do you now explain the difference? (3) If you were the operating surgeon three years from now facing the same case, what specific technical step would you want to practise most before that moment? Answering these questions honestly after every observed operation is how procedural knowledge becomes clinical wisdom.