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Complications of C section & Gynaecological procedures1 .pdf
- 1. Complications of C section & Gynaecological procedures Prepared by : Osama A. Abdulkareem Supervised by : Dr.Khalida Hassan Muho
- 2. • Complications of Caesarean section • Some common gynaecological procedures • Hysterectomy • Biopsies • References Contents
- 4. Haemorrhage
- 5. Haemorrhage • Postpartum hemorrhage is a significant loss of blood ,more than 1000ml after a cesarean section delivery. • it’s the number one reason for maternal morbidity and maternal death around the world. • additional criteria to consider for postpartum hemorrhage include a decrease of 10% or more in hematocrit from baseline, as well as changes in the mother’s heart rate, blood pressure, and oxygen saturations —all of which suggest a significant blood loss.
- 6. • Primary vs secondary or late PPH .
- 7. Tone(Myometrium atony) Multiple pregnancies Multiple pregnancy Micturition(full bladder ) Medications Why does it occur? Trauma Tissue Thrombin
- 8. Management • Prevention and Proper Preparation. • Resuscitation. • Management of underlying cause.
- 9. Resuscitation • Administer oxygen by mask. • Place 2 large-bore (14-gauge) intravenous lines. • Take blood for crossmatch of 6 U PRBCs, and obtain a CBC count, coagulation screen, urea level, creatinine value, and electrolyte status. • Begin immediate rapid fluid replacement with NS or Ringer lactate solution. • Transfuse with PRBCs as available and appropriate.
- 10. Underlying cause Mx. • Massage,bimanual compression,and suture compression. • medications administration(oxytocin,ergonovine,prostaglandin) • Artery ligation,or embolization. • hysterectomy
- 11. • 5-20fold • Risk Factors • M.O.(poly microbial,Ecoli,group B Streptococcus ) • Prevention: I. One dose of first-generation cephalosporin or ampicillin II. Skin Antisepsis III.Careful surgical technique. Infections
- 12. Organs injury What organs? Commonest ? What to do? Foetus?
- 13. Anaesthesia related complications General vs regional ? The mother psychology ?
- 14. Lungs Thromboembolism Mandelson syndrome Post operative atalectasis.
- 15. Placenta Placenta previa Placenta accreta spectrum
- 17. Death
- 20. What is D&C? Is is a procedure in which contents from the inside of the uterus are evacuated. "Dilation" refers to the opening of the cervix. "Curettage" refers to the aspiration or removal of tissue within the uterus with an instrument called a curette.It is both diagnostic and therapeutic. anaesthesia is used? Paracervical block
- 23. Complications 2. Cervical laceration 3. Perforation 4. Bleeding. 5. Infection 6. Adhesion formation(asherman syndrome) 7. Failure.
- 26. What is Asherman syndrome ? is an Acquired uterine condition that occurs when scar tissue (Adhesions) form inside the uterus and/or the cervix. How is it diagnosed ? 1. Hysteroscopy. 2. HSG. 3. Sonohysterography (SHG) with2D or 3D sonar. How to prevent it? 1. Avoiding unnecessarily intrauterine instrumentation 2. Application of IUCD 3. An Uterine balloon stent use 4. A Foley’s catheter placement 5. Anti-adhesion barriers following intrauterine manipulation . How to treat ? Hysterscopic Surgery.
- 28. What is It? Endometrial ablation is a procedure that surgically destroys (ablates) the lining of the uterus (endometrium) . When is it done? Endometrial ablation is an alternative for patients who wish to avoid hysterectomy or who are not candidates for major surgery. What types are there? Electrosurgery,Cryoablation,Microwaves,ballo on ablation etc......
- 29. Sequalae 1. After the procedure the pt.might experience: 2. Perforation 3. Bleeding. 4. Infection 5. Occurrence of pregnancy with complications 6. Failure of resolution of presenting symptom. I. Cramps. II. Vaginal discharge. III. Frequent urination.
- 30. Hysterescopy
- 31. What is Hysterscopy? Is the process of viewing and operating the endometrial cavity from a trans cervical approach. What are the two types ? Rigid and flexible. What media are used? Co2,NS. What type of anaesthesia is used? Paracervical block
- 32. Complications 1. Media related(fluid overload) 2. Perforation 3. Bleeding. 4. Infection 5. Adhesion formation 6. Failure of resolution of presenting symptom.
- 33. Hysterectomy
- 34. Hysterectomy
- 35. Types 1. Abdominal Hysterectomy (AH) 2. Vaginal Hysterectomy (VH) 3. Total Laparoscopic Hysterectomy (TLH) 4. Laparoscopically Assisted Vaginal Hysterectomy Hysterectomy
- 36. Surgery Advantages Abdominal Hysterectomy 1. allows full inspection of the pelvis . 2. Oopherectomy is straightforward 3. Allows removal of large masses like big fibroid. Vaginal Hysterectomy 1. No abdominal incision. 2. Faster recovery. 3. Suitable for spinal anaesthesia 4. Appropriate for frail elderly . LAVH&TLH The main advantages of them are that they offset the disadvantages of AH like abdominal incision ,prolonged period of recovery and pain.
- 37. • Intraoperative: 1. Hemorrhage . Shock 2. Ureteric injuries. 3. Bladder and bowel injury. 4. Anesthetic complications 5. incising the cardinal ligs if the urinary bladder is not sufficiently reflected inferiorly.
- 38. • Postoperative : 1. wound infection. 2. Wound dehiscence. 3. UTI . 4. Thrombophlebitis and thromboembolism. 5. Ureterovaginal fistula. 6. Menopausal symptoms. 7. Depression or Sexual Dysfunction. 8. Incisional hernia. 9. vaginal vault prolapse.
- 39. Biopsies
- 40. Endometrial biopsy • endometrial biopsy is a medical procedure in which a small piece of tissue from the lining of the uterus (the endometrium) is removed for examination under a microscope. The removed tissue is e x a m i n e d f o r c a n c e r o r a n y o t h e r c e l l abnormalities. • It is the most commonly used test for endometrial cancer and is very accurate in postmenopausal women. It can be done in the doctor's office. A very thin, flexible tube is put into the uterus through the cervix. Then, using suction, a small amount of endometrium is removed through the tube. The suctioning takes about a minute or less. The discomfort is a lot like menstrual cramps and can be helped by taking a nonsteroidal anti- inflammatory drug (like ibuprofen) before the procedure. Sometimes a thin needle is used to inject numbing medicine (local anesthetic) into the cervix just before the procedure to help reduce the pain
- 41. Complications 1. Bleeding. 2. Infection 3. Perforation(rare)
- 42. Cervical Biopsy
- 43. Types 1. Punch Biopsy 2. Cone Biopsy- conization 3. Wedge Biopsy 4. Ring Biopsy 5. Surface Biopsy- Pap smear.
- 44. Punch Biopsy • An out patient procedure without anesthesia •Using Cusco’s Bivalve Speculum biopsy is taken from the suspected area or a 4-quadrant using Punch Biopsy forceps. •It can be also Colposcopic directed
- 45. Punch Biopsy
- 46. • Loop electrosurgical excision procedure (LEEP) :uses a thin wire loop heated by electricity to remove the cervical tissue. • Laser surgery :uses a laser (an intense, narrow beam of light) to remove the cervical tissue. Laser surgery is also called laser excision. • Cold-knife excision: uses a surgical knife (scalpel) to remove the cervical tissue. Cone biopsy
- 47. • Loop electrosurgical excision procedure (LEEP) : seems to have Lower incidence long-term side effects than the other types of cone biopsy. Women who become pregnant after LEEP may deliver their babies a little early • Cold-knife excision:has been linked to second- trimester miscarriages and premature delivery. • LaSer surgery :has been linked to Scarring of the cervix, which may make menstrual periods painful. Women who become pregnant after laser surgery may deliver their babies a little early. Cone biopsy
- 48. References
- 49. • Ten teachers books 20th editions(Gyn &Obst) • osmosis.org • Medscape REFERENCES
- 50. • American cancer society . • clevelandclinic.org • hopkinsmedicine.org • webmd.com • ingenes.com • studylib.net • mayoclinics.org REFERENCES
- 51. Pixabay Flaticon