Operative Care Principles

1. Operative Care Principles Managing Complications in Pregnancy and Childbirth These presentation graphics are based on the guide Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors (2000) by the World Health Organization. These presentation graphics are based on the guide Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors (2000) by the World Health Organization.

2. 2 Operative Care Principles Session Objective To review the principles and practices of operative care in emergency obstetrics: Preoperative care Intraoperative care Postoperative care

3. 3 Operative Care Principles Basic Principle The woman is the primary focus of the doctor, midwife and nurse during any operative procedure

4. 4 Operative Care Principles Preoperative Care Prepare the operating theater by ensuring that: The area is clean Necessary supplies and equipment are available, including drugs and oxygen Functioning emergency equipment is available Adequate sterile supplies are available Adequate supply of surgical gowns and other protective gear is available for all members of surgical team

5. 5 Operative Care Principles Preoperative Care (continued) Prepare the woman for surgery by: Explaining the procedure and its purpose, and obtaining informed consent Preparing her emotionally and psychologically Reviewing her medical history for problems, performing appropriate laboratory tests and monitoring vital signs Cleaning proposed surgical area Administering appropriate pre-anesthetic medications and catheterizing her bladder, if necessary Providing relevant information to other team members

6. 6 Operative Care Principles Intraoperative Care Place the woman in a position appropriate for the procedure while ensuring: Optimum exposure of operative site Access for anesthesia and monitoring Safety of woman (and her baby) Dignity and modesty of woman

7. 7 Operative Care Principles Intraoperative Care (continued) Perform a surgical handscrub before gowning: Remove all jewelry Hold hands above level of elbows Wash from fingertips to elbows with soap and water for 3�5 minutes Rinse each hand and arm separately with clean running water, holding hands above level of elbows Dry each hand with a separate clean or disposable towel, wiping from fingertips to elbows

8. 8 Operative Care Principles Intraoperative Care (continued) Clean incision site with antiseptic solution and a cotton or gauze swab: Begin at incision site and clean outward in a circular motion Repeat two more times, using a new swab each time Drape the woman, leaving only the surgical site exposed Monitor vital signs throughout procedure and initiate treatment if condition worsens Maintain adequate pain relief and hydration Give prophylactic antibiotics if appropriate

9. 9 Operative Care Principles Intraoperative Care (continued) Make incision only as large as necessary for procedure Handle tissue gently to minimize tissue damage and decrease risk of infection Keep blood loss to a minimum Leave an abdominal drain in place if bleeding persists or if infection is present or suspected Ensure correct counts of instruments, sharps and sponges at end of procedure Use appropriate type and size of suture for the tissue Cover wound with sterile dressing

10. 10 Operative Care Principles Postoperative Care Initial postoperative care: Place the woman in the recovery position Assess woman�s condition: Monitor vital signs every 15 minutes for first hour and then every 30 minutes for next hour Monitor level of consciousness every 15 minutes until woman is alert Intervene if condition worsens Ensure clear airway and adequate ventilation Maintain adequate hydration and transfuse if necessary Ensure adequate pain relief

11. 11 Operative Care Principles Postoperative Care (continued) Subsequent care: Monitor vital signs and urine output Start on oral fluids as tolerated and move to normal meal; if necessary, give IV fluids until oral fluids are well tolerated Remove dressing after first postoperative day Remove drain after infection has cleared or when there is no drainage for 48 hours Provide adequate pain relief and give antibiotics if indicated Remove urinary catheter as soon as urine is clear Encourage ambulation Remove skin sutures 5 days after surgery