The Anatomy of a C-Section

cesarean sections or c-sections are on the rise and they have been for many years now there's multiple reasons as to why that's true we can't just say it's because women are electing to get them more frequently or that more emerging conditions are occurring that are forcing the c-section that said though if you look at the statistics worldwide which do vary by country it's around 20 to 30 percent of all births are c-section so what we want to do in this video is illuminate some of the mystery behind the procedure itself we're gonna look at the exact issues that are being cut through and get an idea of what she can expect during a c-section let's do this first of all there is no universal procedure for a c-section the type of procedure that's performed depends on a variety of factors including the doctor as well as the circumstances with which it needs to be performed such as is it an emergency section is this designed to save mom and baby's life or is this a planned c-section and this woman received multiple c-sections prior to that so many factors come in to the exact type of incision that's gonna be made but at the end of the day there are a lot of commonalities that modern techniques share and that's what I want to show you today so what we're gonna do is jump on over to the skeleton and look at some skeletal Anatomy that'll give you an understanding of the basic layout and area that they're going to be cutting into during these procedures and this is a real human skeleton pelvis now obviously we've made a few adjustments such as the metal and the paint that illustrates the muscle attachments but it's gonna give us a really good idea of the landmarks that are in the area as they're making their incision and again the incision really does differ depending on the procedure they go with but more or less they're gonna go anywhere from two to five centimeters above this area here called the pubic symphysis to see this piece of cartilage this piece of cartilage connects these two pubic bones we call that the pubic symphysis so the go just a few centimeters up and then they're also going to be going based off of these two landmarks here called the anterior superior iliac spine or ASIS so they're gonna go a couple centimeters in mediate in the medial direction make their transverse or curvilinear incision and then stop another couple centimeters before they were to reach that ASIS again though it does depend on which procedure they end up doing the height they make this initial transverse cut so when they make this initial transverse cut in the abdomen they're only cutting through the superficial layers of the abdomen or the integumentary system so this is the epidermis dermis and hypodermis or the subcutaneous tissue which is comprised mainly of fat cells and they do this because they don't want to cut into the muscle underneath because that is going to increase recovery time dramatically and can be a huge risk of complications so what they're going to do is they make that and then they're gonna start tearing the tissue away from itself and this sounds kind of aggressive but the idea here is this will lessen recovery time as well you see if you use a sharp tool such as a scalpel for everything you're doing you've increased the likelihood of severing blood vessels and just making it much more difficult for that tissue to heal so they're gonna use their hands and blunt ends to an instrument as much as possible to try and just reveal the deeper tissues which are going to be connective tissue and muscle because they're going to need to make a second cut so once they've kind of revealed and enough space they should be able to see what's going to be called the rectus sheath and the rectus sheath is just a connective tissue layer that surrounds the rectus abdominis muscle and we can see that right here with this particular cadaver so what you'll notice is we have the umbilicus or the belly button left on and you can also see that so we have the epidermis dermis and then deep to it you can see all this fatty tissue it's padding tissue is that subcutaneous tissue that they're going to be cutting through so this is kind of nice you can see all the layers that they would be cutting through as they do that really low transverse cut which is often referred to as the bikini line cut but once they do that and they've exposed enough of the area they can see this tissue here called the rectus sheath so all this white connective tissue this is called the rectus sheath and it just lies just on top of the muscle tissue the rectus abdominus so we've kind of cut away some of the rectus sheath to reveal the rectus abdominus on this side and left it intact here so what the rectus sheath is is it's a tendon it's a tendon that emerges from the obliques which are on the sides and you can see the obliques here so we can see the fibers of external oblique and then I can kind of flip that over and we can see the fibers of internal oblique and then I can flip that yet again and we can see the fibers of transversus abdominus so in between these layers is a bunch of collagen fibers and what will happen is they will then branch out and envelop the rectus abdominus in this connective tissue layer that we call the rectus sheath so when the obliques contract it kind of tighten but compresses the abdomen so what's interesting too is when all of those connective tissues live connective connective tissue layers converge they converge right in the center and they form this white line that goes right down the center of the abdomen called the Linea Alba and it really is a white line that's what Linea Alba means we can see that right here so all of this is the Linea Alba going up towards that sternum and this is a gap between the muscles and this is what they're looking for when they start making their the second cut they want to make that cut through the Linea Alba so they're not cutting through muscle tissue so they will reveal away or kind of cut away or remove part of that rectus sheath just so they can see enough of the Linea Alba to then cut or tear their way through again depends on the specific technique they use but once they do that they're then gonna meet another layer that's called the peritoneum and if I flip this over we can see what this peritoneal is going to look like and that's what this is right here this is all the parrots Neum on the inside of the rectus abdominus so then they're going to make their way through this and that's when they would run into the uterus so what we're gonna do is jump on over to a different cadaver so we can see the uterus and get a better understanding of the next type of incisions that are gonna be made as you can see the rectus sheath is completely intact on this cadaver and we've also made an incision that goes around the lower aspect of the abdomen and I want to be very clear that is not at all what they do during the c-section that's something we did in order to be able to see the underlying Anatomy but remember there's this white line here called Linea Alba so if we had removed that rectus sheath you'd be able to see that Linea Alba much more clearly and what they do is they make an incision in going vertically through that Linea Alba and then separating the two rectus abdominus muscle heads and as they did that does it reflect this back you can see that parrots neum that I mentioned earlier they'd have to go through this next because I pull this back we see a giant piece of tissue that you really wouldn't have to worry much about during a normal c-section called the greater omentum this is a fatty apron like tissue that drapes over the intestines you have to remember in a full-term pregnancy this thing would have kind of gotten pushed out of the way so they really don't have to do much wrestling with this but it's a really interesting piece of tissue but I'm just gonna fall back and we meet the small intestines and again the small intestines would also be kind of out of the way you see the uterus would have pushed them to the side and they would have also slipped behind the uterus in most cases so as I pull these small intestines out of the way we can see the uterus and that's what this is right here and obviously it's smaller I mean she was in her mid 90s so we can't expect her to have the uterus the size of a full-term pregnancy this is pretty cool we can also see an ovary right here on the side as it connects to this uterine tube but this uterus just picture is they would open this up they've cut through the peritoneum they would see this uterus just jetting out like this so what they would do and again it depends on the procedure they'll make a cut typically the incision is going to be transverse again and it's going to then just be in the rough position of where the infant's head is so they can then birth the infant as well as the placenta right they have to get that placenta and amniotic sack and everything else out not just the infant but as they bird that they would then stitch that uterus closed and sometimes some procedures they even pull the uterus out and so as they stitch it they have to come up put it back in and rotate it and put it into this cavity that you're seeing right here but again it would be much much bigger and then the intestines and everything will kind of fall around it I mean it's obviously the uterus is going to be smaller now that it doesn't have an infinite side of it but it's still gonna be pretty big but they don't really do much putting of the tissues back because they really only have a small window the body will take care of most of that by itself but what they will do depending on thinking this depends on the technique sometimes they will actually if I put this back some techniques will stitch and suture this peritoneum closed others won't some techniques will actually stitch the subcutaneous fat closed and others won't it really depends but what they have to do once they've put all the tissues back they'd put the uterus in place they have to suit your shut the integument the epidermis and the dermis and when they do that at that point the c-section is done it's really interesting to think about just how far we've come with c-sections historically they were only performed in order to save the baby's life because they became it's such a high mortality rate for the mother they didn't want to do it unless they absolutely had to but again nowadays like I mentioned earlier we're hovering around that 20 to 30 percent average worldwide it's amazing to see just how far we've come now there's something else I do want to briefly mention and that is something that we're just starting to learn and understand the effect on the microbiome of the infant as its form by a c-section you see normally as the infant is born through the vaginal canal mom's vaginal secretions which are coated in good bacteria will then coat the infant the infant will even swallow that and it will help create a different microbiome population eventually inside of the digestive tract but when they're being born by c-section we're finding a completely different microbiome profile and that's going to be more similar to the skin on the mother as well as even the operating room itself with which the infant is born now we're still not sure of what consequences this will have later on in life if any at all but it's so interesting to note that there's just differences in even the microbiome based on whether it's a c-section or a vaginal birth I know for me I'm very interested to see where this will go as we learn more throughout the years but hopefully this gave you a better understanding as to what's going on with a c-section or at least the anatomy that they're cutting through as they perform it be sure to LIKE comment subscribe if you haven't already and I will see you in the next video [Music] you [Music]

Channel: Institute of Human Anatomy

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Keywords: c section, caesarean section (medical treatment), cesarean section, cesarean section childbirth, pfannenstiel incision cesarean, pfannenstiel c section, pfannenstiel incision video, institute of human anatomy, c-section recovery, institute of human anatomy tiktok, childbirth, cesarean section approach, cesarean section scar revision, cesarean section pictures, cesarean section for placenta previa, healing after c-section, cesarean section incision numbness, childbirth band

Id: ckQzMtptw4w

Length: 11min 36sec (696 seconds)

Published: Fri Mar 06 2020