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.
