• Electrosurgery

    Electrosurgery – principles, technique, and proper nomenclature. Module by: Dr. Neeraj Mehra Learning Objectives Understand the basic differences between monopolar (cut/coag) and bipolar energy. Understand how energy settings relate to tissue effects.

  • Basic Surgical Skills and Tips

    Resources Surgical Care at the District Hospital (WHO) – Chapter Four (PDF) Surgical Knot Tying Basics Intermediate suturing and knot tying skills for gynecology Suture Choices Chapter 39 of OER Africa: Procedures in Obstetrics and Gynaecology has excellent descriptions of the above video for suture and needle choice Basic Gynecologic…

  • Uterine Incision Extensions

    Uterine incision extensionsModule by: Tina Gao. Risk factors Arrest of the first or second stage Fetal malposition (e.g. OP, asynclitic) Macrosomia Failed forceps or vacuum delivery Chorioamnionitis Abnormal fetal heart rate Prematurity Factors cluster into the following categories of risk factors for lateral extension of a transverse uterine incision: Difficulty…

  • Visceral Injury During CS

    Urinary tract and bowel injury at the time of Cesarean section.Module by: Margaret Burnett. Learning objectives Minimize urinary and gastrointestinal tract injury during cesarean section Recognize unintended visceral injury intraoperatively Use best practice in repairing bladder and gastrointestinal lacerations Manage postoperative care following visceral injury Introduction Injury to the urinary…

  • Visceral Injuries – Summary

    Fortunately, visceral injuries during cesarean section are rare. Prevention is key. Maintain a high index of suspicion in cases where pelvic adhesions are likely to be present (including if your patient has had previous surgery). Inspect the surface of the bowel or bladder at the site of lysed adhesions. Enter the…

  • Postop care of visceral injury

    Post-op management of urinary tract injury Foley in situ for 7-10 days. Bladder lacerations typically heal well within 7 days of repair.  Monitor for symptoms and signs of hydronephrosis, renal compromise or urinoma. The patient may be discharged home with instructions to return if symptoms arise. Prophylactic antibiotics are not…

  • Gastrointestinal injury

    Gastrointestinal injury at the time of cesarean section is rare, approximately 1/1000 cesarean deliveries.  Most injuries are minor lacerations amenable to primary repair at the time of laparotomy Generally occur at the time of abdominal entry or lysis of adhesions.  Intraoperative diagnosis is critical. Thermal injury to the bowel or…

  • Ureteric injury

    Ureteric injury may occur by laceration, crushing or errant suture placement. Risks include: Extension of the angles of a transverse incision Hysterectomy Deep bladder lacerations that involve the trigone Presentation: Many ureteric injuries are not appreciated at the time of cesarean section.  Postoperative fever, flank pain and abdominal distention may…

  • Bladder injury

    Most commonly occurs at the time of abdominal entry or with dissection of the bladder flap away from the lower uterine segment Majority are bladder dome lacerations (95%) Previous cesarean contributes by: Creating adhesions between bladder and lower uterine segment Tethering the dome of the bladder higher than expected on…

  • Immediate and Surgical Management

    Management If a cord is seen extending past the introitus with pulsations, keep the cord warm with a saline soaked cloth and avoid manipulation. Attempt to place the mother in Trendelenburg or bring knees to chest to help keep the presenting part off of the cord. If the cord is…