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Obstetric Surgery

Obstetric Surgery Managing Complications in Pregnancy and Childbirth Session Objectives To describe general principles of obstetric surgery To describe common surgical procedures in emergency obstetric care Basic Principle

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Obstetric Surgery

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  1. Obstetric Surgery Managing Complications in Pregnancy and Childbirth

  2. Session Objectives • To describe general principles of obstetric surgery • To describe common surgical procedures in emergency obstetric care Obstetric Surgery

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

  4. Pre-Operative Care • Ensure that the operating room is fully functional • Prepare the woman for surgery by explaining to her the procedure to be done and its purpose. Obtain her informed consent • Review her medical history for problems and indication for surgery and do appropriate laboratory tests • Administer appropriate pre-anesthetic medications Obstetric Surgery

  5. Intra-Operative Care • Place the woman in a position appropriate for the procedure • Ensure sterile technique • Handle tissue gently—minimize tissue damage • Ensure hemostasis, adequate pain relief and hydration • Monitor her condition throughout the procedure and initiate treatment if condition worsens Obstetric Surgery

  6. Postoperative Care • Ensure clear airway, ventilation, hydration and pain relief • Monitor vital signs and level of consciousness every 15 minutes until she is awake and her condition is stable • Start on oral fluids as tolerated and change to normal meal • Encourage ambulation • Remove skin sutures when the wound has healed Obstetric Surgery

  7. Common Obstetric Surgery • Cesarean section • Salpingectomy for ectopic pregnancy • Laparotomy for ruptured uterus • Postpartum hysterectomy Obstetric Surgery

  8. Cesarean Section • May be done under local, spinal or general anesthesia • Anticipate and prepare for problems during childbirth (e.g., difficulty in delivering a head deep in the pelvis) • Vertical abdominal incision is preferred if local anesthesia is used • Open the lower segment of the uterus transversely and deliver the newborn, placenta and membranes • Give prophylactic antibiotic and oxytocin • Close the uterus and abdomen after ensuring hemostasis Obstetric Surgery

  9. Problems Encountered During Cesarean Section • Difficulty in controlling bleeding • Oxytocics, massage, sutures • Uterine and utero-ovarian artery ligation, hysterectomy • Difficulty in delivering malpresentation • Anticipate and perform appropriate manipulations for childbirth • Placenta previa/Adherent placenta • Incise placenta and deliver • Hysterectomy if placenta cannot be removed or uncontrollable bleeding Obstetric Surgery

  10. Cesarean Section: Post-Procedure Care • Watch for postpartum bleeding • Give oxytocin infusion after surgery • Give adequate analgesia and hydration • Encourage early feeding and ambulation • Explain what was done and its implications to the woman Obstetric Surgery

  11. Salpingectomy for Ectopic Pregnancy • May be done under spinal or general anesthesia • Open the abdomen and identify the fallopian tube with the ectopic pregnancy • Clamp the mesosalpinx to stop bleeding • Do a salpingectomy • Check the other tube, ovaries and other pelvic organs for pathology • Close the abdomen after giving prophylactic antibiotics • Give adequate analgesia and hydration • Encourage early feeding and ambulation • Explain what was done and its implications to the woman Obstetric Surgery

  12. Laparotomy for Ruptured Uterus • May be done under spinal or general anesthesia • Open the abdomen and deliver the newborn and placenta • Lift the uterus out of the incision to visualize the extent of the rupture. Suture together the edges of the rupture. If repair is not possible, do hysterectomy • Examine the bladder for rupture and repair if ruptured Obstetric Surgery

  13. Laparotomy for Ruptured Uterus (continued) • Close the abdomen after giving prophylactic antibiotics and oxytocin infusion • Leave drain if hemostasis is not satisfactory • Give adequate analgesia and hydration • Encourage early feeding and ambulation • Explain what was done and its implications to the woman Obstetric Surgery

  14. Postpartum Hysterectomy • May be done under spinal or general anesthesia • Hysterectomy may be • Subtotal if cervix is left behind • Total if the cervix is removed • Lift the uterus out through the incision and compress it to reduce bleeding • Clamp and divide round ligament, tubes and ovarian ligaments but ligate pedicles after uterine artery has been tied • Separate the urinary bladder away from the lower segment Obstetric Surgery

  15. Postpartum Hysterectomy (continued) • WARNING: The ureters are close to the uterine vessels • For sub-total hysterectomy: Ligate the uterine arteries and amputate the uterus just above this level • For total hysterectomy: Divide cardinal ligaments to remove cervix • Close the stump • Ensure hemostasis. Leave drain if hemostasis is not satisfactory • Give adequate analgesia and hydration • Encourage early feeding and ambulation • Explain what was done and its implications to the woman Obstetric Surgery

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