CC Chua, Prince Robert C.

November 27, 2020

Group 2-A

Reflection Paper 4C

Peripartum cesarean section hysterectomy is done at the time or within 24 hours of delivery.
Cesarean hysterectomy can be classified as emergent, indicated non-emergent, or for elective sterilization.
Emergency cases would be due to uterine hemorrhage, placental problems, or infection. The most
common indication for emergency procedures is severe uterine hemorrhage that cannot be controlled by
conservative measures. The video started by showing engorged vascularities which is also known as “bag
of worms”. A high classical cesarean section incision was performed. The baby was delivered feet first and
the fetal head was delivered last. It appears that there was not enough care in handling the fetal head.
There could be damage to the fetal head or nerves if there was mishandling of the fetal head. The round
ligament was cut and suture was ligated. The utero-ovarian ligament was cut and ligated along with the
fallopian tube at the utero-tubal junction. The bladder was distended and the vesico-uterine fold was
lowered. The uterine arteries were cut and suture ligated. The feeding vessel from anterior lower uterine
segment to posterior wall of the bladder was cut and ligated. Incision was then performed in the vaginal
canal. The vaginal cuff was closed. The rest of the video shows the gross view of the uterus. The video was
able to explain each step in the procedure. I appreciate the details in the explanations of every step of the
procedure. The parts of the gross view of the uterus were properly labeled. The procedure was done
smoothly and quickly by the team. The team members know their role in the procedure and were able to
effectively perform their individual tasks. It would be better if the equipment used in each step was
mentioned in the video. There was no mention of the names of the equipment used in the procedure. The
camera was able to show the entire procedure clearly. The video was also able to show the indication of
the cesarean section hysterectomy. The engorged veins were properly visualized before and after removal
of the uterus. The clamping of ligaments was done properly and demonstrated in the video clearly.
However, the proper close of the surgical site was not demonstrated in the video. I learned that it is
important to clamp all the necessary blood supply involved in the uterus prior to cutting out the uterus.
This is to prevent bleeding of the patient. I also learned that proper teamwork is necessary in doing
surgical procedures. As demonstrated in the video, a lot of the steps in the procedure are done by
members of the team. A single operator cannot perform the procedure alone. It is vital to procedures
such as this the importance of knowing one’s responsibilities and communicating properly with team
members.