The hand surgeon is introduced into the uterine cavity in such a way that surface lay her hands to the head of the fetus. This hand turns head or back of the head face forward and manufactures its unbending or bending, so that the head is released from the uterus. If you have a pelvic praevia, the child is removed for the front inguinal crease or leg. When transverse position of the fetus's hand, introduced into the womb, the fetus looks for a leg, produced podalic and its subsequent extraction. This head appears through a hole in the uterus receiving identical Admission MAURICE Levrault with vaginal rodoraz-solving. Umbilical cord overlap between clamps, and the newborn is transferred midwife. In the muscle of the uterus into force on 1 ml metilergometrina. A light pandiculation for the umbilical cord and placenta separates allocated seq. In case of difficulty, the placenta can be separated by hand. After selecting the afterbirth uterine wall tested a large blunt curette that ensures removal of fragments of shells, blood clots and improves the reduction uterus.

Fourth point. The wound of the uterus stacked two rows myshech-but-muscular seams. The ends of the seams overlap by 1 cm lateral incision in the angle netravmirovannuyu wall of the uterus to provide reliable hemostasis. When imposition of the first of a number of stitches has been successfully used technique Eltsova - small arms, where the nodes are immersed in the uterine cavity. This is captured by the mucous shell and part of the muscle layer.Vkol and pluck needles made from mucosa, resulting in the nodes after tying themselves located on the part of the uterus. The second layer of muscles and muscle joints compares the entire thickness of the muscular layer of the uterus. Knotty ketgutovye seams superimposed in such a way that they were located between the seams of the previous series.

Peritonizatsiya produced by vesico-uterine fold, which filed ketgutovym seam on 1,5-2 cm above the cut. The line opening lower segment of the uterus is covered by the bladder and does not coincide with the line peritonizatsii. Of the abdominal tissues are removed, and the abdominal wall sutured in layers tightly. At the peritoneum superimposed continuous ketgutovy suture, starting from the upper corner of the wound. Continuous suture ketgutovym converge recti,then superimposed node joins in the aponeurosis and the nodal ketgutovye seams on the subcutaneous fat. Rana skin sutured with silk,lavsan nodal or nylon sutures.

In some cases, after abdominal cesarean section performed supravaginal or hysterectomy.The indications for hysterectomy, produced after Caesarean, are as follows:

1) uterine fibroids, requiring surgical treatment, due to size, topography of sites, the presence of complications;

2) uterine rupture, precluding the possibility of suturing;

3) utero-placental apoplexy (uterus Kuvelera);

4) true placenta accreta;

5) metroparalysis if bilateral tubal vessels does not lead to reduction of the uterus and stop bleeding;

6) in rare cases, massive infection of the uterus.