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


CULDOCENTESIS

1 Apply antiseptic solution to the vagina (especially the posterior fornix).
2 Provide emotional support and encouragement. If necessary, use local
infiltration with lidocaine.
3 Gently grasp the posterior lip of the cervix with a tenaculum and gently pull to elevate the cervix and expose the posterior vagina.
4 Place a long needle (e.g. spinal needle) on a syringe and insert it through the posterior vagina, just below the posterior lip of the cervix (Figure 12.10).
Figure 12.10
Figure 12.10

5 Pull back on the syringe to aspirate the pouch of Douglas (the space behind the uterus):
If non-clotting blood is obtained, suspect ectopic pregnancy
If clotting blood is obtained, a vein or artery may have been aspirated; remove the needle, re-insert it and aspirate again
If clear or yellow fluid is obtained, there is no blood in the peritoneum; the woman may, however, still have an unruptured ectopic pregnancy and further observations and tests may be needed
If no fluid is obtained, remove the needle, reinsert it and aspirate again; if no fluid is obtained, the woman may have an unruptured ectopic pregnancy
If pus is obtained, keep the needle in place and proceed to colpotomy.

> 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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