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H. Gee MD, FRCOG Consultant Obstetrician
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Aims Reduce complication rate at c-section Infection Haemorrhage
Damage to other organs
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Post operative sepsis Where Prevent Wound Uterus Hand washing
Bladder Prevent Hand washing Patient washing Reduce VE Sterile instruments Prophylactic antibiotics
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How to Reduce Sepsis Critical incident review Audit
Evidence - Standards Detect where can improve Institute improvement Re-audit
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Bladder Injury Heavy Haematuria
Leave catheter in for 10 days if blood stained ? Antibiotics
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Haemorrhage Good haemostasis C-section at right time
Avoid Prolonged Labour Avoid Obstructed Labour Clotting abnormalities in abruption
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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
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Communication with anaesthetist
Warn anaesthetist oxytocin/ergometrine/misoprotol ready Tell anaesthetist immediately excessive bleeding starts Increase fluids Get blood transfusion
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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
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Audit Audit Standards Identify factors Institute change Re-audit
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Who needs Subtotal hysterectomy?
Placenta accreta Ruptured uterus & cannot repair Placenta praevia severe bleeding from lower segment Atonic uterus not responding to treatment
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B- LYNCH SUTURE
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