Obstetrics and Gynecology - A.M. Gromova 2000

Operative Obstetrics
Operations performed in the third stage of labor and the early postpartum period
Supravaginal amputation of the uterus

Indications for surgery:

— following Caesarean section in uterine Muscle hypotonia;

— in the presence of uterine fibroids and Pregnancy;

— in cases of hypotonic subcompensated bleeding during the Third Stage of labor;

— in obstetric Peritonitis of various etiologies;

— when performing a Caesarean section under conditions of maternal systemic infection.

Surgical technique.

Following the incision of the abdominal wall via a lower midline laparotomy, the Uterus is grasped and inspected. It is then retracted to one side, and two clamps are applied: one to the round ligament of the uterus, and the other to the proper ovarian ligament and fallopian tube. Counter-clamps are applied to prevent retrograde venous bleeding. These structures are transected, transfixed, and ligated. The upper margin of the broad ligament is incised between the placed clamps. The clamps are replaced with ligatures. The uterus is retracted to the opposite side and the same steps are performed. Then, pulling the uterus back, the vesicouterine fold is incised, the Urinary Bladder is separated from the cervix, and the peritoneal incision is extended to both sides. Pulling the uterus to the side, clamps and counter-clamps are applied to the uterine vessels, which are then ligated, transected, and secured with ligatures on both sides.

At the level of the internal os, the uterus is amputated from the cervix. 3–4 catgut sutures are applied to the cervical stump to approximate its anterior and posterior portions.

Peritonization is performed using a continuous catgut suture. First, a fine needle is used to puncture the posterior wall of the cervical stump, followed by the corresponding edge of the Peritoneum of the vesicouterine fold. The cervical stump is thus peritonealized. Then, using the same ligature, peritonization of the stumps of the round ligaments and adnexa is continued. A purse-string suture is applied. After tightening the purse-string suture, the stumps of the cervix and adnexa are retroperitonealized.

Following hemostasis control and exploration of the Abdominal cavity, the abdominal wall is closed in layers.