| 1 |
Give
a single dose of prophylactic antibiotics. |
| 2 |
Open
the abdomen:
| • |
Make
a midline vertical incision below the umbilicus
to the pubic hair, through the skin and to the level
of the fascia |
| • |
Make
a 2–3 cm vertical incision in the fascia;
hold the fascial edge with forceps and lengthen
the incision up and down using scissors |
| • |
Use
fingers or scissors to separate the rectus muscles
(abdominal wall muscles) |
| • |
Use
fingers to make an opening in the peritoneum near
the umbilicus |
| • |
Use
scissors to lengthen the incision up and down in
order to see the entire uterus. Carefully, to prevent
bladder injury, use scissors to separate layers
and open the lower part of the peritoneum |
| • |
Place
a bladder retractor over the pubic bone and place
self-retaining abdominal retractors. |
|
| 3 |
Pull
on the uterus to expose the lower part of the broad ligament. |
| 4 |
Feel
for pulsations of the uterine artery near the junction
of the uterus and cervix. |
| 5 |
Using
0 chromic non absorbable (or polyglycolic) suture on
a large needle,
pass the needle around the artery and through 2–3 cm of myometrium
(uterine muscle) at the level where a transverse lower uterine segment
incision would be made. Tie the suture securely. |
| 6 |
Place
the sutures as close to the uterus as possible, as the
ureter is generally
only 1 cm lateral to the uterine artery. |
| 7 |
Repeat
on the other side. |
| 8 |
If
the artery has been torn, clamp and tie the bleeding
ends. |
| 9 |
Ligate
the utero-ovarian artery just below the point where the
ovarian suspensory ligament joins the uterus (Figure
12.23). |
|
| 10 |
Repeat
on the other side. |
| 11 |
Observe
for continued bleeding or formation of haematoma. |
| 12 |
Close
the abdomen. Ensure that there is no bleeding. Remove
clots using a sponge. Examine carefully for injuries to
the bladder and repair any found. |
