Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Emergency Obstectric Care
Hypertension in Pregnancy
Hypertension
Assessment and management
Delivery
Postpartum care
Chronic hypertension
Complications
Management of Slow Progress of Labour
General principles
Slow progress of labour
Progress of labour
Operative procedures
Bleeding in Pregnancy and Childbirth
Bleeding
Diagnosis and initial management
Specific management
Procedures
Aftercare and follow-up
Procedures
 


> MANUAL VACUUM ASPIRATION
> DILATATION AND CURETTAGE
> CULDOCENTESIS
> COLPOTOMY
> SALPINGECTOMY FOR ECTOPIC PREGNANCY
> REPAIR OF RUPTURED UTERUS
> MANUAL REPAIR OR PLACENTA
> REPAIR OF CERVICAL TEARS
> REPAIR OF VAGINAL AND PERINEAL TEARS
>

UTERINE INVERSION

> UTERINE AND UTERO-OVARIAN ARTERY LIGATION
> POSTPARTUM HYSTERECTOMY


The preferred method of evacuation of the uterus is by manual vacuum aspiration (see above). Dilatation and curettage should be used only if manual vacuum aspiration is not available.

1 Follow the initial steps as described under Manual Vacuum Aspiration.
2 Gently pass a uterine sound through the cervix to assess the length and direction of the uterus. Gently introduce a large curette. Use graduated dilators only if the curette will not pass. Begin with the smallest dilator
and end with the largest dilator that ensures adequate dilatation (usually 10–12 mm) (Figure 12.8). Take care not to tear the cervix or to create a false opening.
Figure 12.8
Figure 12.8

3 Evacuate the contents of the uterus with a large curette or ring forceps (Figure 12.9). Gently curette the walls of the uterus until a grating sensation is felt.
Figure 12.9
Figure 12.9

4 Perform a bimanual pelvic examination to check the size and firmness of the uterus. Examine the evacuated material. Send material for histopathological examination, if required.


Post-procedure care

1 Give paracetamol 500 mg by mouth as needed.
2 Encourage the woman to eat, drink and walk about as she wishes.
3 Offer other health services, if possible, including tetanus prophylaxis,
counselling or a family planning method.
4 Discharge uncomplicated cases in 1–2 hours.
5 Advise the woman to watch for symptoms and signs requiring immediate
attention:
Prolonged cramping (more than a few days)
Prolonged bleeding (more than 2 weeks)
Bleeding more than normal menstrual bleeding
Severe or increased pain
Fever, rigor, malaise
Fainting.

 

 

> MANUAL VACUUM ASPIRATION
> DILATATION AND CURETTAGE
> CULDOCENTESIS
> COLPOTOMY
> SALPINGECTOMY FOR ECTOPIC PREGNANCY
> REPAIR OF RUPTURED UTERUS
> MANUAL REPAIR OR PLACENTA
> REPAIR OF CERVICAL TEARS
> REPAIR OF VAGINAL AND PERINEAL TEARS
>

UTERINE INVERSION

> UTERINE AND UTERO-OVARIAN ARTERY LIGATION
> POSTPARTUM HYSTERECTOMY



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