Download
h gee md frcog consultant obstetrician n.
Skip this Video
Loading SlideShow in 5 Seconds..
H. Gee MD, FRCOG Consultant Obstetrician PowerPoint Presentation
Download Presentation
H. Gee MD, FRCOG Consultant Obstetrician

H. Gee MD, FRCOG Consultant Obstetrician

623 Views Download Presentation
Download Presentation

H. Gee MD, FRCOG Consultant Obstetrician

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  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