Managing Complications in Pregnancy and Childbirth: - IAWG

REPAIR OF RUPTURED UTERUS P-95• Review for indications.• Review operative care principles (page C-47) and start an IVinfusion (page C-21).• Give a single dose of prophylactic antibiotics (page C-35):- ampicillin 2 g IV;- OR cefazolin 1 g IV.• Open the abdomen:- Make a midline vertical incision below the umbilicus to thepubic hair, through the skin and to the level of the fascia;- Make a 2–3 cm vertical incision in the fascia;- Hold the fascial edge with forceps and lengthen the incisionup and down using scissors;- Use fingers or scissors to separate the rectus muscles(abdominal wall muscles);- Use fingers to make an opening in the peritoneum near theumbilicus. Use scissors to lengthen the incision up and downin order to see the entire uterus. Carefully, to prevent bladderinjury, use scissors to separate layers and open the lower partof the peritoneum;- Examine the abdomen and the uterus for site of rupture andremove clots;- Place a bladder retractor over the pubic bone and place selfretainingabdominal retractors.• Deliver the baby and placenta.• Infuse oxytocin 20 units in 1 L IV fluids (normal saline or Ringer’slactate) at 60 drops per minute until the uterus contracts and thenreduce to 20 drops per minute.• Lift the uterus out of the pelvis in order to note the extent of theinjury.• Examine both the front and the back of the uterus.• Hold the bleeding edges of the uterus with Green Armytage clamps(or ring forceps).