Managing Complications in Pregnancy and Childbirth: - IAWG

Caesarean sectionP-49CLOSING THE ABDOMEN• Look carefully at the uterine incision before closing the abdomen.Make sure there is no bleeding and the uterus is firm. Use a spongeto remove any clots inside the abdomen.• Examine carefully for injuries to the bladder and repair any found(page P-97).• Close the fascia with continuous 0 chromic catgut (or polyglycolic)suture.Note: There is no need to close the bladder peritoneum or theabdominal peritoneum.• If there are signs of infection, pack the subcutaneous tissue withgauze and place loose 0 catgut (or polyglycolic) sutures. Close theskin with a delayed closure after the infection has cleared.• If there are no signs of infection, close the skin with verticalmattress sutures of 3-0 nylon (or silk) and apply a sterile dressing.• Gently push on the abdomen over the uterus to remove clots fromthe uterus and vagina.PROBLEMS DURING SURGERYBLEEDING IS NOT CONTROLLED• Massage the uterus.• If the uterus is atonic, continue to infuse oxytocin and giveergometrine 0.2 mg IM and prostaglandins, if available. Thesedrugs can be given together or sequentially (Table S-8, page S-28).• Transfuse as necessary (page C-23).• Have an assistant press fingers over the aorta to reduce thebleeding until the source of bleeding can be found and stopped.• If bleeding is not controlled, perform uterine and utero-ovarianartery ligation (page P-99) or hysterectomy (page P-103).