H. Gee
MD, FRCOG
Consultant Obstetrician
Aims
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•
•
•
Reduce complication rate at c-section
Infection
Haemorrhage
Damage to other organs
Post operative sepsis
• Where
– Wound
– Uterus
– Bladder
• Prevent
– Hand washing
– Patient washing
– Reduce VE
– Sterile instruments
– Prophylactic antibiotics
How to Reduce Sepsis
• Critical incident review
• Audit
– Evidence - Standards
– Detect where can improve
– Institute improvement
– Re-audit
Bladder Injury
Heavy Haematuria
• Leave catheter in for 10 days if blood
stained
• ? Antibiotics
Haemorrhage
• Good haemostasis
• C-section at right time
– Avoid Prolonged Labour
– Avoid Obstructed Labour
– Clotting abnormalities in abruption
Obstructed labour
• Impacted head –
– Disimpact before start
– Midwife push up from below
• Thin lower segment – tears –
• Release pressure slowly
• High incision top lower segment
• Lift uterus out of abdomen to see tears before
suturing
Communication with
anaesthetist
• Warn anaesthetist
– oxytocin/ergometrine/misoprotol ready
• Tell anaesthetist immediately excessive
bleeding starts
– Increase fluids
– Get blood transfusion
How to reduce Haemorrhage
• Critical incident review/Reflective practise– If got to hospital just in time
• Very thin lower segment –
– thank midwife ambulance driver
– WHY BABY/MOTHER DIED
• NO TRAINING – did not fill in partogram
• NO EQUIPMENT – no transport
• MATERNAL HEALTH VERY POOR
Audit
• Audit
– Standards
• Identify factors
• Institute change
• Re-audit
Who needs Subtotal
hysterectomy?
• Placenta accreta
• Ruptured uterus & cannot repair
• Placenta praevia severe bleeding from
lower segment
• Atonic uterus not responding to treatment
B- LYNCH SUTURE