La césarienne . Fig. 33.-Césarienne avec hystérectomie supra-vaginale : Tubes andOvaries conservés : Placenta non fournie. I, ligament rond fixées ; 2, tube et ligament large fixées ; 3, anteriorperitoneal ; Volet 4, artère utérine fixées ; 5, l'incision dans l'utérus. longue incision abdominale est faite pour permettre la livraison de l'unopeneduterus à partir de l'abdomen et la protection intégrale d'peritonealcavity par emballage de gaze, de sorte que le danger d'infection de l'peritoneumby le contenu utérin infecté est réduite au minimum. Le placenta 148 césarienne est habituellement laissé in utero.

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Cesarean section . Fig. 33.—Cesarean Section with Supravaginal Hysterectomy: Tubes andOvaries Retained: Placenta Undelivered. I, Round ligament clamped; 2, tube and broad ligament clamped; 3, anteriorperitoneal flap; 4, uterine artery clamped; 5, incision in cervix. long abdominal Incision is made to permit the delivery of the unopeneduterus from the abdomen and the complete protection of the peritonealcavity by gauze packing, so that the danger of infection of the peritoneumby the infected uterine contents is reduced to a minimum. The placenta 148 CESAREAN SECTION is ordinarily left in utero. The patient is now placed in the Trendelen-burg position. The tuhes, ovarian, and round ligaments on each side areligated a short distance from the uterus, clamps are placed between theuterus and the ligatures, and the tissues between the clamps and liga-tures are divided. The broad ligament on either side is divided down. Fig. 34.—Cesarean Section with Supravaginal Hysterectomy.Method of suturing cervical stump: tubes and ovaries intact. to its base. A curved incision is now made across the anterior surfaceof the uterus just above the bladder reflection and a peritoneal flappeeled o-ff by blunt dissection. The uterine arteries are then isolated, tied, and cut, and the body of the uterus is amputated at the cervical junc-tion. The cervical canal is cauterized, either by the actual cautery or bycrude carbolic acid, and the stump is sutured so as to close and bury SPECIAL METHODS OF OPERATION 149 the canal by the necessary number of catgut sutures, covered by theperitoneal flap, and then dropped back into the peritoneal cavity. Thebroad ligament wounds are closed with continuous catgut sutures. Thegauze packing is then removed and the pelvic cavity is sponged out care-fully and the abdominal wound closed. In infected cases it is a wise pre-caution to sponge out the pelvis with 70 per cent alcohol and a s

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