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


UTERINE AND UTERO-OVARIAN ARTERY LIGATION

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).
Figure 12.23
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.


Post-procedure care

If there are signs of infection or the woman currently has fever, give a combination of antibiotics until she is fever-free for 48 hours. Give appropriate analgesic drugs. If there are no signs of infection, remove the abdominal drain after 48 hours.

> 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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