Obstrectric operation

1. OPERATIVE OBSTETRICS
PRESENTED BY
Mrs Nagamalar
Annamalai University

2. INTRODUCTION
Obstetric operation are surgical
procedures and as such irrespective of
the nature of operation (major or
minor)
asepsis and antiseptic precaution are
to be taken as outlined.

3. LIST OF OPEARATIVE OBSTETRICS
 Dilatation and evacuation
 Management protocol of uterine perforation
 Suction evacuation
 Menstural regulation
 Manual vaccum aspiration
 Hystrectomy
 Episiotomy
 Operative vaginal delivery
 Forceps
 Ventous
 Version
 Destructive operation
 Caesarean section

4. Following preliminaries are to be followed while operative obstetrics
• Anaesthesia
• Lithotomy position
• Full surgical asepsis
• Empty the bladder

6. DILATATION AND EVACUATION
•The operation consists of dilatation of
the cervix and evacuation of the
products of conception from the uterine
cavity

7. TYPES
TWO STAGE
OPERATION
SECOND PHASE
Rapid dilatation
of cervix and
evacuation
FIRST
PHASE
Slow dilatation
of cervix
ONE STAGE
OPERATION
DILATATION AND
EVACUATION
DONE IN THE
SAME SITTINGS

8. INDICATIONS
ONE STAGE OPERATION
• INCOMPLETE ABORTION
(COMMONEST)
• INEVITABLE ABORTION
• MEDICAL TERMINATION OF
PREGNANCY (6-8 WEEKS)
• HYDATIDIFORM MOLE
TWO STAGE OPERATION
• INDUCTION OF 1ST TRIMESTER
ABORTION (COMMONEST)
• MISSED ABORTION (uterus8-
10weeks)
• HYDATIDIFORM MOLE (with
unfavourable cervix)

9. INSTRUMENTS

10. ONE STAGE PROCEDURE

12. PRELIMINARIES
• ANESTHESIA-either general or local is used .in some cases the operation may be performed with intravenous
diazepam sedation.
• LITHOTOMY position
• FULL SURGICAL ASEPSIS is to be taken;
-surgical team is to wear sterile cap ,mask thorough hand wash and to wear
gown and gloves
-vulva and vagina are to be swabbed with antiseptic solution
-cervix is cleaned with povidone-iodine solution
-leggings
• empty the bladder
• Vaginal examination done
• Pudendal block or perineal infiltration with 1% lignocaine is sufficient.

13. cont
• Vaginal examination done
• Pudendal block or perineal infiltration with 1%
lignocaine is sufficient.
• It may be applied even without aneasthesia, especially in
paras women`
• The instrument should be assembled

14. Sims posterior
vaginal speculum
is introduced
Anterior lips of
cervix is grasped
by an allis forceps
Cervical canal is
gradually dilated
up
Products are
removed by ovum
forceps
Inj methergin
0.2mg iv is
introduced
Uterine cavity is
curetted gently
speculum & allies
forceps are
removes
Uterus is
massaged
bimanually
Sterile vulval pad
is placed
Patient is send
back to her bed
Procedure
steps

15. POST ABORTION CARE
• Family planning counselling and referral services
• male partners should be involved
• Emergency treatment of abortion complication
• Comprehensive services

16. TWO STAGE OPERATION

17. PROCEDURES
First phase (slow dilatation of cervix)
• Consists of introduction of laminaria tents or
lamicel (mgso4)sponge in to cervical canal to effect
its slow dilatation
• May be effective by intravaginal insertion of
misoprostal(PGE1)400 mcg 3 hours before
surgery(less side effect)

19. Steps of introduction tents