Managing Complications in Pregnancy and Childbirth: - IAWG

POSTPARTUM HYSTERECTOMY P-103Postpartum hysterectomy can be subtotal unless the cervix and loweruterine segment are involved. Total hysterectomy may be necessary inthe case of a tear of the lower segment that extends into the cervix orbleeding after placenta praevia.• 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.• If there is uncontrollable haemorrhage following vaginal delivery,keep in mind that speed is essential. To 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.• If the delivery was by caesarean section, clamp the sites ofbleeding along the uterine incision:- In case of massive bleeding, have an assistant press fingersover the aorta in the lower abdomen. This will reduceintraperitoneal bleeding;- Extend the skin incision, if needed.