Obstetrics and Gynecology - A.M. Hromova 2000

Operative Obstetrics
Operations performed in the third stage of labor and the early postpartum period
Hysterectomy

Indications:

- hypo- and aphibrinogenemic uterine Hemorrhage;

- obstetric Peritonitis;

- Uterine rupture.

Surgical technique.

Following a lower midline laparotomy, the Uterus is grasped, delivered into the wound, and examined. After applying clamps on both sides, the round ligament of the uterus and the proper ovarian ligament along with the fallopian tube are ligated and transected. Pulling the uterus backward, the vesicouterine peritoneal fold is incised, and the incision is extended to the round ligament on each side. The Urinary Bladder is separated from the cervix down to the level of the external cervical os. Clamps are applied to the uterine vessels, and the vessels are severed. Kocher clamps are placed on the Base of the parametrium; the parametrial tissue is ligated near the uterine margin. The uterus is pulled upward. The uterosacral ligaments are ligated and severed; the posterior peritoneal leaf is incised between them. Next, the vaginal fornices are opened at the site of their attachment to the cervix. Through the opening in the fornix, the Vagina is disinfected with an iodine solution. The incision is enlarged, and either the anterior or posterior lip of the cervix is grasped through it with Museux forceps. The cervix is amputated from the vaginal fornices, and the uterus is removed. The vaginal stump is closed with sutures. Peritonization is performed. Following inspection of the Abdominal cavity, the abdominal wall is closed in layers. Urinary bladder catheterization is performed, and the vagina is treated once more.

Control questions

1. What surgical Procedures are performed during the Third Stage of labor and the early postpartum period?

2. Technique for Manual Separation and removal of the Placenta.

3. Indications for Manual Exploration of the uterine cavity.

4. Technique for manual exploration of the uterine cavity.

5. What conditions contribute to perineal lacerations?

6. Classification of perineal tears.

7. Technique for repairing perineal lacerations depending on the degree of the tear.

8. Causes of cervical rupture.

9. Classification of cervical tears and the technique for their repair.

10. Indications for ligation of major uterine vessels.

11. Indications for supracervical amputation and extirpation of the uterus.

12. Technique for uterine amputation.

13. Technique for uterine extirpation.