• Management: Approach after C/S

    Approach to Management of PPH following Cesarean Section I. Cesarean Section Delivery with 1000-1500mL estimated blood loss, with ongoing excessive bleeding and/or mild tachycardia and/or hypotension. Consider 4 T’s: Tone:  GA may cause uterine atony ,prolonged labour, chorioamnionitis, polyhydramnios Tissue:  rule out abnormal placentation Trauma:  Manual and visual exploration of…

  • Setup: Instruments and Materials

    Setup for Repairing Lower Genital Tract Lacerations Materials for Repairing Lacerations For all repairs Additional, for Higher Order or Complex tears Sterile drapes and gloves Foley catheter Irrigation solution (warm sterile saline or water) Allis clamps (for anal sphincter repairs) Needle driver Ring forceps (for cervical repairs) Suture scissors Tissue…

  • CS – Delivery

    Delivery of the Head Slide your fingers between the head and the lower part of the incision​ Keep your hand stiff so it forms a “slide” for the baby’s head while the assistant pushes on the uterine fundus​ Don’t fight the contraction, direct the head through the incision during relaxation phase​ Assistant may push…

  • CS – Uterine Incision

    Lower Segment (Transverse) Thin myometrium therefore less blood loss, quicker entry​ Lower risk of catastrophic uterine rupture in future pregnancies​ Width is restricted by uterine arteries and Azygos plexus​ May have to create a “T” incision to obtain adequate exposure  The choice of uterine incision largely depends on the indication…

  • Review Process

    Modules Prioritized (complete) Modules Assigned, with planned review date (goal 4 weeks) Content Creator makes initial documents (Word, PowerPoint, etc) Initial documents circulated to reviewers (curriculum working group, current residents, etc) and comments / edits are made in online version of Word, PowerPoint files (goal 2 weeks) Content Creator makes…

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  • Emergency Peripartum Hysterectomy

    Peripartum Hysterectomy ​ incidence : 0.24 to 8.9 per 1000 deliveries (1.2 to 2.7 per 1000 deliveries in USA, Europe <1)​ after vaginal delivery : 0.1 to 0.3/1000​ with CS:  0.2 to 8.7/1000 deliveries ​ higher due to risk of placenta praevia with placenta acreta in repeat c-sections​ uterine rupture : 114/1000 to 455/1000  In most cases,…