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H. Gee MD, FRCOG Consultant Obstetrician

H. Gee MD, FRCOG Consultant Obstetrician. Aims. 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.

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H. Gee MD, FRCOG Consultant Obstetrician

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  1. H. GeeMD, FRCOGConsultant Obstetrician

  2. Aims • Reduce complication rate at c-section • Infection • Haemorrhage • Damage to other organs

  3. Post operative sepsis • Where • Wound • Uterus • Bladder • Prevent • Hand washing • Patient washing • Reduce VE • Sterile instruments • Prophylactic antibiotics

  4. How to Reduce Sepsis • Critical incident review • Audit • Evidence - Standards • Detect where can improve • Institute improvement • Re-audit

  5. Bladder InjuryHeavy Haematuria • Leave catheter in for 10 days if blood stained • ? Antibiotics

  6. Haemorrhage • Good haemostasis • C-section at right time • Avoid Prolonged Labour • Avoid Obstructed Labour • Clotting abnormalities in abruption

  7. 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

  8. Communication with anaesthetist • Warn anaesthetist • oxytocin/ergometrine/misoprotol ready • Tell anaesthetist immediately excessive bleeding starts • Increase fluids • Get blood transfusion

  9. 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

  10. Audit • Audit • Standards • Identify factors • Institute change • Re-audit

  11. Who needs Subtotal hysterectomy? • Placenta accreta • Ruptured uterus & cannot repair • Placenta praevia severe bleeding from lower segment • Atonic uterus not responding to treatment

  12. B- LYNCH SUTURE

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