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


REPAIR OF CERVICAL TEARS

1 Apply antiseptic solution to the vagina and cervix.
2 Provide emotional support and encouragement. Anaesthesia is not required
for most cervical tears.
3 Ask an assistant to massage the uterus and provide fundal pressure.
4 Gently grasp the cervix with ring or sponge forceps. Apply the forceps on both sides of the tear and gently pull in various directions to see the entire cervix. There may be several tears.
5 Close the cervical tears with continuous 0 chromic non absorbable (or polyglycolic) suture starting at the apex (upper edge of tear), which is often the source of bleeding (Figure 12.15). If a long section of the rim of
the cervix is tattered, under-run it with continuous 0 chromic non absorbable (or polyglycolic) suture.
6 If the apex is difficult to reach and ligate, it may be possible to grasp it with artery or ring forceps. Leave the forceps in place for 4 hours. Do not persist in attempts to ligate the bleeding points as such attempts may increase the bleeding. Then after 4 hours, open the forceps partially but do not remove.
7 After another 4 hours, if the bleeding has not recurred, remove the forceps completely.


A laparotomy may be required to repair a cervical tear that has extended deep beyond the vaginal vault.


> 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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