Managing Complications in Pregnancy and Childbirth: - IAWG

UTERINE AND UTERO-OVARIAN ARTERY P-99LIGATION• 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;- Place a bladder retractor over the pubic bone and place selfretainingabdominal retractors.• Pull on the uterus to expose the lower part of the broad ligament.• Feel for pulsations of the uterine artery near the junction of theuterus and cervix.• Using 0 chromic catgut (or polyglycolic) suture on a large needle,pass the needle around the artery and through 2–3 cm ofmyometrium (uterine muscle) at the level where a transverse loweruterine segment incision would be made. Tie the suture securely.• Place the sutures as close to the uterus as possible, as the ureter isgenerally only 1 cm lateral to the uterine artery.• Repeat on the other side.• If the artery has been torn, clamp and tie the bleeding ends.