Abdominal Delivery

Question 1

What is a supracervical hysterectomy?

Answer 1

Uterine body ligated above the level of the uterine artery ligation

Indicated for:
- Patients too sick to withstand long surgeries
- Those with extensive lower segment adhesions and extend the anterior hysterotomy posteriony

Question 2

How can the presence of a urinary bladder injury be identified?

Answer 2

Presence of clear-fluid gush
Foley cath bulb is visible
To confirm: Retrograde fluid through urinary catheter
Inspect ureters

Repair:
- instillation
- Closed in 2-3 layers
- Running suture 3-0 absorbable
Inspect for leaks
Leaks are closed with interrupted suturing

Question 3

What are some manifestations of unrecognized urinary bladder injury?

Answer 3

Hematuria, oliguria, abdominal pain, ileus, ascites, peritonitis, fever, urinome, fistula

Question 4

What are some key points in post-operative care for abdominal delivery and peripartum hysterectomy?

Answer 4

Euvolemia Evaluation
Ensure adequate hydration
Monitor vital signs and urine output
Transfer to postpartum ward
At least 1 hour of monitoring in the recovery suite prior to transfer
Hospital care until discharge
Pain control
Continuous monitoring of vital signs every 4 hours
Deep breathing exercise
Repeat Hgb after 24 hours post-op
Early ambulation
Bowel and bladder function
Remove foley catheter 6-12 hours post-op
General liquids/solids given gradually passage of flatus and stool
Ambulation and wound care: Early ambulation, walk to bathroom with assistance
Abdominal binders to encourage deep breathing
Change dressing after 24 hours
3rd post-op day: showering may be allowed but plastic covering on wound is advised
Hospital discharge: Uncomplicated case, 3-4 days hospital stay, 1st week: activity limited to self-care, Driving may resume if pain would not limit ability to break quickly

Question 5

Euvolemia Evaluation

Answer 5

Ensure adequate hydration

Lactated Ringers Solution with Dextrose 5% given
Monitor vital signs and urine output

Question 6

Transfer to postpartum ward

Answer 6

At least 1 hour of monitoring in the recovery suite prior to transfer

Monitor uterus if well contracted, minimal vaginal bleeding, stable VS, adequate urine output

Question 7

Hospital care until discharge

Answer 7

Pain control
Continuous monitoring of VS every 4 hours
Deep breathing exercise
Repeat Hgb after 24 hours post-op
Early ambulation
Bowel and bladder function

Remove foley catheter 6-12 hours post-op
General liquids/ solids given gradually passage of flatus and stool

Question 8

Ambulation and wound care

Answer 8

Early ambulation: walk to bathroom with assistance
Abdominal binders to encourage deep breathing
Change dressing after 24 hours
3rd post-op day: showering may be allowed but plastic covering on wound is advised

Hospital discharge
Uncomplicated case: 3-4 days hospital stay
1st week: activity limited to self care
Driving may resume if pain would not limit ability to break quickly