Managing Complications in Pregnancy and Childbirth: - IAWG

Operative care principlesC-51HAEMOSTASIS• Ensure haemostasis throughout the procedure.• Women with obstetrical complications often have anaemia.Therefore, keep blood loss to a minimum.INSTRUMENTS AND SHARPS• Start and finish the procedure with a count of instruments, sharpsand sponges:- Perform the count every time a body cavity (e.g. uterus) isclosed;- Document in the woman’s record that the surgical counts werecorrect.• Use instruments, especially sharps, carefully to reduce the risk ofinjury (page C-20). Use “safe zones” when handling and passinginstruments and sharps:- Use a pan such as a kidney basin to carry and pass sharpitems and pass suture needles on a needle holder;- Alternatively, pass the instrument with the handle, rather thanthe sharp end, pointing toward the receiver.DRAINAGE• Always leave an abdominal drain in place if:- bleeding persists after hysterectomy;- a clotting disorder is suspected;- infection is present or suspected.• A closed drainage system can be used or a corrugated rubber draincan be placed through the abdominal wall or pouch of Douglas.• Remove the drain once the infection has cleared or when no pus orblood-stained fluid has drained for 48 hours.