Cesarean section . ough the anterior vaginal wall from a little above theurethra to the external os (Fig. 48). The bladder is then separated fromthe anterior surface of the cervix and lower uterine segment by bluntdissection, preferably with the gloved finger covered by a piece of gauze,at first by touch alone; but later a large retractor is introduced into thewound and the separation is completed under the guidance of the bladder is drawn up behind the retractor, thus exposing the wholeanterior wall of the uterus from the anterior lip of the cervix to thecontraction ring with a pair o
Cesarean section . ough the anterior vaginal wall from a little above theurethra to the external os (Fig. 48). The bladder is then separated fromthe anterior surface of the cervix and lower uterine segment by bluntdissection, preferably with the gloved finger covered by a piece of gauze,at first by touch alone; but later a large retractor is introduced into thewound and the separation is completed under the guidance of the bladder is drawn up behind the retractor, thus exposing the wholeanterior wall of the uterus from the anterior lip of the cervix to thecontraction ring with a pair of heavy, straight scissors. A median in- 154 CESAREAN SECTION cision is now made about lo centimeters long, extending from the marginof the external os to practically the level of the contraction ring. Thespeciiliini is removed, one hand is introduced into the uterus, the mem-branes are ruptured, and the child turned and extracted. If the child isdead or non-viable, it is a wise precaution to perforate the head and. Fig. 48.—Vaginal Hysterotomy. thus render extraction of the after coming head more easy, since thesmaller the head the less the liability of damage to the uterus in case theincision is too short. The placenta is extracted manually and the opera-tion is completed by suturing the wound. Traction on the sutures introduced at the commencement of the opera-tion, or on the French hooks, will now bring the whole uterine incisioninto view as a triangular opening, and it is readily closed from abovedownward by interrupted sutures of chromic catgut, which are Intro- VAGINAL CESAREAN SECTION 195 duced, under the guidance of the eye, care being taken tO place the upper-m©st stitch just above the upper angle of the wound. The incision in thevaginal mucosa is then closed by a continuous catgut suture. Some op-erators prefer to introduce a small rubber drain into the dead spacewhich always remains between the bladder and the vaginal mucous mem-
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