Managing Complications in Pregnancy and Childbirth: - IAWG

SALPINGECTOMY FOR ECTOPIC PREGNANCY P-109• 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.• Identify and bring to view the fallopian tube with the ectopicgestation and its ovary.• Apply traction forceps (e.g. Babcock) to increase exposure andclamp the mesosalpinx to stop haemorrhage.• Aspirate blood from the lower abdomen and remove blood clots.• Apply gauze moistened with warm saline to pack off the bowel andomentum from the operative field.• Divide the mesosalpinx using a series of clamps (Fig P-58 A–C,page P-110). Apply each clamp close to the tubes to preserveovarian vasculature.• Transfix and tie the divided mesosalpinx with 2-0 chromic catgut (orpolyglycolic) suture before releasing the clamps.