HYSTEROTOMY

HYSTEROTOMY

DESCRIPTION

            The hysterotomy is a technique of electively terminating a pregnancy after 20 weeks of gestation or when vaginal route is not possible. In this method, a surgical procedure similar to cesarean section is performed with all the same risks and complications associated with a cesarean delivery. It is reserved for special circumstances, such as when other abortion methods have failed, and usually is not the primary abortion method chosen.

            The fetus is usually killed prior to or at the time of the delivery, usually by cutting the umbilical cord to prevent the fetus from getting oxygen. Occasionally a fetus will survive and may have to be killed after delivery by the health care provider or allowed to die on its own through neglect. Many countries have laws in place to cover any fetus that is born during an abortion and survives the procedure, but cases have been documented of such babies being left to die.

REASONS FOR PROCEDURE

·       Personal concerns about the social or economic aspects that involve an uplanned pregnancy.

·       Continuing with the pregnancy may pose a threat to the life of the mother.

·       Pregnancy resulted from a rape.

·       Fetus is affected with a major disorder such as chromosomal abnormality or birth defects.

·       Fear that the fetus has been harmed by medications or other conditions.

RISKS INCREASES WITH

« Obesity

« Smoking

« Poor nutrition

« Recent or chronic illness

« Use of drugs such as anti-hypertensive; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; narcotics; beta-adrenergic blockers; or cortisone.

« Use of mind- altering drugs including narcotics; psychedelics; hallucinogens; marijuana; sedative; hypotics; cocane.

ARTICLES REQUIRED

v Kidney tray-2

v Sponge holder-2

v Gauze swabs

v Sponges

v Basin

v Green armitage-6

v Long artery forceps-4

v Short artery forceps-4

v Mosquito forceps-4

v Doyins retractor

v Devers retractor

v Cord clamps-2

v Curved scissor-1

v Straight scissor-1

v Betadine solution

v Suction tube and catheters

Sutures

R 1 vicryl

R Catgut

R Vicryl rapid

DESCRIPTION OF PROCEDURE

ª A general anesthesia is used.

ª An incision is made in the abdomen and then in the uterus. Fetal tissue and placenta are removed.

ª The uterus wall is sewed back together and the abdominal opening closed.

EXPECTED OUTCOME

R Termination of the pregnancy.

R Complete healing without complications.

POSSIBLE COMPLICATIONS

1.     Immediate

2.     Remote

IMMEDIATE

à Excessive bleeding

à Surgical-wound infection

à Depending upon the type of uterine scare, there is often an increased risk of uterine rupture in a future pregnancy.

§  Peritinitis

§  Intestinal Obstruction

§  Anesthetic hazards, all these lead to increased morbidity and occasional death.

REMOTE

     Menstrual abnormality-menorrhagia or irregular periods.

     Scar endometriosis (1%).

     Scar rupture in subsequent pregnancy.

POST OPERATIVE CARE

GENERAL MEASURES

§      Use of sanitary pads for bleeding, which may last for several days. If bleeding continues 10-14 days after surgery, tampons can be used.

§      If pain is present place a heating pad or hot-water bottle on the abdomen or back. Hot baths frequently promote muscule relaxation and relieve discomfort. Repeat the baths as often as they provide comfort.

§      If contraception is desired, it can often be initiated shortly after the procedure. If the client wishes to take birth controlling pills, begin taking them either on the night she returns from surgery or the next day. If the client prefers an IUD, diaphragm or cervical cap, the fitting can be made during clinical appointment.

§      The next menstrual period should begin 4-6 weeks after the procedure. If the client is on birth controlling pills, the first period will began after the completion of the first cycles of pills.

MEDICATIONS

ü  Prescription pain medication should generally be required for only 2-7 days following the procedure.

ü  Non-prescription drugs, such as acetaminophen, for pain can be used.

ü  Antibiotics may be prescribed to reduce risk of infection.

ü  Stool softener, laxative, if needed to prevent constipation.

ACTIVITY

Ø  Resuming normal activities normally.

Ø  Avoiding sexual relations for 4-6 weeks after surgery.

DIET

No special diet. The client has to notify the clinician if any of the following occurs:

o   Pain, swelling, redness or drainage increases in the surgical area.

o   Signs of infection; headache; muscle aches; dizziness or general ill feeling and a temperature of over 100⁰ orally.

o   New, unexplained symptoms develop. Drugs used in treatment may produce side effects.