CC Chua, Prince Robert C.

November 25, 2020

Group 2-A

REFLECTION PAPER 4A

Patients who have had a previous cesarean section have the option of undergoing a trial of labor
after cesarean delivery or repeat cesarean delivery. The medical and obstetric benefits of repeat cesarean
delivery are the avoidance of the potential adverse outcomes seen in trial of labor after cesarean delivery.
These potential adverse outcomes are primarily uterine rupture and morbidity associated with
intrapartum cesarean delivery. The video started with the surgical site sterilized with iodine and the
patient was properly draped with sterilized sheets. Skin incision was done to remove the scar from the
previous cesarean section. The subcutaneous layer was then incised to gain access to the peritoneum.
Suctioning was done to remove the blood and provide a clear view of the site. A low segment uterine
cesarean section was performed. The uterus was opened and the membranes were ruptured by the
clinician. The baby was delivered by holding the fetal head and pushing out the anterior shoulder. Drying
of the baby and cord clamping was done. Traction was then applied to the umbilical cord. This is to assist
in the delivery of the placenta. Pressure was also applied on the abdominal area to assist in the delivery
of the placenta. The uterus was clamped in multiple areas and the repair of the uterus was started. The
steps were clearly explained and demonstrated in the video. However, the equipment used in every step
was not identified. The repair of the first layer of the uterus was clearly demonstrated in the video. The
bleeding was suctioned immediately by the assistant to clear the surgical field. The clinician was able to
suture the incisions quickly. Repair of the abdominal layers of the skin were then sutured at the end of
the procedure. The video was able to capture all the procedures in a clear view for the students. Audio
instructions of the steps in the procedure done would be greatly appreciated to further enhance the
students’ learning. There was no mention of the indication for repeat cesarean section in this patient. The
indication of the primary cesarean section was also not mentioned in the video. I learned that after a
previous cesarean section, the patient may opt to have a trial of labor or a repeat cesarean section. If the
previous indication for cesarean section was not due to cephalopelvic disproportion, then the patient can
decide to undergo trial of labor after cesarean delivery. If the patient’s previous cesarean section was also
a low segment cesarean section, then she is a candidate for trial of labor for this current pregnancy. I
learned that the surgical team should know their roles in every step of the procedure for efficient
performance during the entire procedure. Good communication among the members of the team is
essential for proper teamwork. In delivering the baby, it is important to be careful when handling the fetal
head. This is to avoid any fetal head complications or nerve injuries.