H. Gee MD, FRCOG Consultant Obstetrician

1. H. GeeMD, FRCOGConsultant Obstetrician

2. Aims • Reduce complication rate at c-section • Infection • Haemorrhage • Damage to other organs

3. Post operative sepsis • Where • Wound • Uterus • Bladder • Prevent • Hand washing • Patient washing • Reduce VE • Sterile instruments • Prophylactic antibiotics

4. How to Reduce Sepsis • Critical incident review • Audit • Evidence - Standards • Detect where can improve • Institute improvement • Re-audit

5. Bladder InjuryHeavy Haematuria • Leave catheter in for 10 days if blood stained • ? Antibiotics

6. Haemorrhage • Good haemostasis • C-section at right time • Avoid Prolonged Labour • Avoid Obstructed Labour • Clotting abnormalities in abruption

7. Obstructed labour • Impacted head – • Disimpact before start • Midwife push up from below • Thin lower segment – tears – • Release pressure slowly • High incision top lower segment • Lift uterus out of abdomen to see tears before suturing

8. Communication with anaesthetist • Warn anaesthetist • oxytocin/ergometrine/misoprotol ready • Tell anaesthetist immediately excessive bleeding starts • Increase fluids • Get blood transfusion

9. How to reduce Haemorrhage • Critical incident review/Reflective practise- • If got to hospital just in time • Very thin lower segment – • thank midwife ambulance driver • WHY BABY/MOTHER DIED • NO TRAINING – did not fill in partogram • NO EQUIPMENT – no transport • MATERNAL HEALTH VERY POOR

10. Audit • Audit • Standards • Identify factors • Institute change • Re-audit

11. Who needs Subtotal hysterectomy? • Placenta accreta • Ruptured uterus & cannot repair • Placenta praevia severe bleeding from lower segment • Atonic uterus not responding to treatment

12. B- LYNCH SUTURE