Laparotomy can be done in two ways: median incision between the navel and pubic and transverse suprapubic incision on

Pfannenstiel.Suprapubic incision has several advantages: when it is observed less reaction on the part of the peritoneum in postoperative period, it is more in harmony with the cut of the lower segment of the uterus, Makeup, rarely the cause of postoperative hernias.

When performing lateral suprapubic incision the skin and subcutaneous tissue cut along the natural folds in the suprapubic sufficient distance (up to 16-18 cm). Aponeurosis middle incision with a scalpel, and then peel off with scissors in the transverse direction, and they also dissected in form an arc. After this region aponeurosis captured Kocher clamps, and aponeurosis peels from direct and oblique abdominal muscles down to the two pubic bones and up - to the umbilical ring. In the white line abdominal aponeurosis cut off with scissors or a scalpel. At the two edges of the rugged aponeurosis applied to 3 ligatures or time with catching the edges of napkins, which lay round oneself operative field. To achieve better access to some cases performed suprapubic incision in the modification Czerny,at which the dissected apo-neurotic straight leg muscles on both sides for 2-3 see

Parietal peritoneum is dissected in the longitudinal direction from the umbilical ring to the upper edge of the bladder. Second time. After the delimitation of the abdominal cavity napkins vesico-uterine fold of peritoneum is opened at the site of his greatest mobility scissorswhich then under the peritoneum is made in the course of each sidefold and dissected in the transverse direction. Bladder tupferom easily separated from the lower segment of the uterus and moves downward. After This is determined by the level of the section of the lower segment of the uteruswhich depends location of the head of the fetus. At the level of greatest diameter of the head scalpel incision performed most of the lower segment until the autopsy membranes. In section introduces index fingers of both hands, and the hole in the uterus is expanded to the sides until the moment when her fingers felt they reached the extreme points of the head.