1. H. Gee MD, FRCOG Consultant Obstetrician

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

3. Post operative sepsis Where Prevent Wound Uterus Hand washing
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 Injury Heavy 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 – Thin lower segment – tears –
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