Intraoperative Lecture Dr. Mrs P. Somvanshi

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INTRAOPERATIVE BLEEDING DURING LSCS

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Dr. Pushpa Junghare Somvanshi Prof. & Head Obs.Gyn Dr. P.D.M.M.C. , Amravati

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Sources / Causes Skin incision Injury to epigastric vessels From uterine incision Due to extension of inci sion * Laterally to involve uterine vessels * Downwards to involve the vascular area between LUS & bladder * Upwards into upper uterine highly vascular segment * Placental site bleeding

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Skin Incision Sharp, precise & clean cut incision in one stroke Vessels running across, near the angles or along the edges

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Rectus sheath incision Do not stretch / separate the muscles

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Vessels running across the LUS Use of A llis tissue forceps

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Separation and extraction of placenta

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Closure of uterine wound

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Uterine massage

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Achieve complete haemostasis before closure

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Bleeders underneath / within the muscles

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Oozing from subcutaneous tissue & fat

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Stitch in time saves nine

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Bleeding per vagina * Uterine atony * Distension of uterus / LUS

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* Bimanual Uterine massage * Uterotonics

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PV examination & digital removal of clots

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Finally when one is satisfied that no bleeders are left unattended and uterine atony well tackled, only then the patient be shifted out of OT.

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Thank You