Managing Complications in Pregnancy and Childbirth: - IAWG

Caesarean sectionP-51• Women with placenta praevia are at high risk of postpartumhaemorrhage. If there is bleeding at the placental site, under-runthe bleeding sites with chromic catgut (or polyglycolic) sutures.• Watch for bleeding in the immediate postpartum period and takeappropriate action (page S-25).POST-PROCEDURE CARE• Review postoperative care principles (page C-52).• If bleeding occurs:- Massage the uterus to expel blood and blood clots. Presenceof blood clots will inhibit effective uterine contractions;- Give oxytocin 20 units in 1 L IV fluids (normal saline orRinger’s lactate) at 60 drops per minute and ergometrine 0.2 mgIM and prostaglandins (Table S-8, page S-28). These drugscan be given together or sequentially.• If there are signs of infection or the woman currently has fever,give a combination of antibiotics until she is fever-free for 48 hours(page C-35):- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours.• Give appropriate analgesic drugs (page C-37).HIGH VERTICAL (“CLASSICAL”) INCISION• Open the abdomen through a midline incision skirting theumbilicus. Approximately one-third of the incision should be abovethe umbilicus and two-thirds below.• Use a scalpel to make the incision:- Check the position of the round ligaments and ensure that theincision is in the midline (the uterus may have twisted to oneside);- Make the uterine incision in the midline over the fundus of theuterus;