Introduction

Cesarean Section
Caesarean section, also known as C-section, or caesarean delivery, is the surgical
procedure by which one or more babies are delivered through an incision in the
mother's abdomen, often performed because vaginal delivery would put the baby or
mother at risk.

The most common indications for primary cesarean delivery include labor dystocia,
abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple
gestation, and suspected fetal macrosomia.

Scenario: Cesarean Section, 36 yrs old, P1G2

Role Playing:

Scene 1: OR preparation
*handwashing*
*prep instruments*
CN: checks OR light, etc. Open kit of instruments.
SN: checks instruments
Counting:
CN: sharps, kelly, etc.
-allis clamp (3)
-Kelly (3)
-knife handle
-curved kelly
-straight kelly
-tissue forcep
-thumb forcep
-richardson retractor
-forceps
-kocher
-umbilical cord clamp
-bandage scissor
-bladder blade
- army navy, goulet
-babcocks
-scissors
-addisons
-suction tube
-needle
-kidney basin
 - Sponges (4)
SN: states number

CN: Ready to use for operation.

Scene 2: Receives patient from OB ward

OB nurse (Lara): Good afternoon. Endorsing patient Maria Ligaya, 36 years old. Birthdate is
July 1, 1985. Primi 1 gravida 2, for cesarean operation.

Weight: 70 kg
Height: 5’5
Blood type: AB
Medical history: Covid-19
Family history: Hypertension
Allergies: none
Comorbidity: none
Medications taken: none
CN: Good afternoon Ms. Maria Ligaya. *introduce self* *get patient consent*
CN: *checks vital signs*
T: 36.7
Blood pressure: 110/70
RR: 21
HR: 88
FHR: 120
O2 Sat: 99

SN: *check kung nakuha VS and consent*

Scene 3: Transfer patient to OR table

*handwashing*
*SN scrubbing*
Gowning and assist gowning
CN: *transfer and position patient in OR table*

Narrator (Sca): Surgical team arrives. Scrub nurse assists for gowning and gloving.
CN: *positions patient in lateral position, drapes, skin prep of lumbar part*
Anesthesiologist: *perform or administer anesthesia*

CN: *preps abdomen*

SN: *setup mayo table, draping*

Counting:
CN: sharps, kelly, etc.
 -allis clamp
-knife handle
-curved kelly
-straight kelly
-richardson retractor
-forceps
-kocher
-umbilical cord clamp
-bandage scissor
-bladder blade
- army navy, goulet
-babcocks
-scissors
-addisons
-suction tube
-sponge
SN: states number

CN: sharps, needles, sponges are counted complete. Ready to use for operation.
CN: Good afternoon. Please state your name and position.
Surgeon: Dra. Marquez, surgeon
Anesthesiologist: Dr. Abraham, anesthesiologist
Pediatrician: Dra. Concordia, pediatrician
Student Nurse: En Conejos, student nurse

Surgeon: This is Mrs. Maria Ligaya, 36 years old,female. We’re doing a cesarean section. She
is in supine position; we have our ultrasound on the walls; no specimen needed; surgery will be
for 2 hours.
Anesthesiologist: Mrs. Maria Ligaya is under general anesthesia, no antibiotics given, no
allergies.
SN: Sterility has been carefully observed.

Surgeon: Cutting time?

CN: 12:51 pm

Narrator: *ongoing operation*

Surgeon: Allis clamp

SN: *hands over allis*
Narrator:surgeon uses an Allis clamp to pinch the patient’s skin down near where the incision
will be cut to assess for numbness.
Surgeon: Scalpel
SN: *hands over scalpel*
Narrator: the skin incision is made with the scalpel
Surgeon: Kelly clamp
SN: *hands over Kelly*
Narrator: As the subcutaneous tissue (including adipose layer) is separated, Kelly clamps are
used to hold tissue
Surgeon: Scalpel
SN: *hands over scalpel*
Narrator: When the fascia is reached, it may be scored with the scalpel
Surgeon: Kocher
SN: *hands over Kocher*
Narrator: Kochers are used to hold the fascia
Surgeon: scalpel
SN: *hands over scalpel*
Narrator: Once the uterus is exposed the bladder blade is put in place. The scalpel is used to
cut a small line in the uterus.
Surgeon: umbilical cord clamp
SN:
Surgeon: Bandage scissors
SN:
Narrator: Once the baby’s body is delivered to the maternal abdomen, Peans are used to clamp
the umbilical cord, bandage scissors to cut it.
Surgeon: baby out 2:15 pm
Surgeon: ring forcep
SN:
Surgeon: sponge
Narrator: The placenta is then manually removed. A Ring forcep may be used to grasp
membranes. A wet lap sponge is used to clean the uterine wall.

Narrator: Before closing the incision, circulating and scrub nurse counts sponges and
instruments.

Counting:
CN: sharps, kelly, etc.
-allis clamp
-knife handle
-curved kelly
-straight kelly
-richardson retractor
-forceps
-kocher
-umbilical cord clamp
-bandage scissor
-bladder blade
- army navy, goulet
-babcocks
 -scissors
-addisons
-suction tube
-sponge
SN: states number

CN: sharps, needles, sponges are counted completely.

Narrator: Surgeon is now suturing the incision. Scrub nurse is now putting dressing on the
incision site.

*clears away instruments, de-gowning, documentation*

SN: charting
CN: endorse patient to PACU, assists in VS