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PREOPERATIVE MANAGEMENT, POSTOPERATIVE MANAGEMENT, INTRAOPERATIVE…
PREOPERATIVE MANAGEMENT
Consultation & Investigation
Age & Parity
Basic investigation
Blood group & Rhesus
FBC
LFT
RP
Blood glucose level
Medical dsz & allergies
Previous surgeries
Types & duration of surgeries
Patient’s wishes & expectations
BMI & vital signs
Management & consultation
Bowel preparation
Good hydration
Prophylactic antibiotics
Thromboprophylaxis
Treat anaemia
Optimise sugar
Correct electrolyte
Anaesth review
Discontinue certain medication
Risk factors identification
Comprehensive history taking
Physical examination
Assess medical status
Identify physical limitations
Consent
POSTOPERATIVE MANAGEMENT
Monitor potential complications
Fluid, electrolyte & acid-base balance
Wound care
Homeostasis
Clean
Analgesia
Skin closure
Dressing & follow up advice
Relevant investigation
FBC & coagulation profile
Blood glucose
RP
CXR
ABG + serum lactate
Surgical site assessment
Pain management
Plan for relevant post operative care plan
INTRAOPERATIVE MANAGEMENT
Caesarean section
Indications
Failure to progress during labour
Not reassuring fetal status
Fetal presentation
No absolute contraindications
Complications
Haemorrhage
Bowel damage
Urinary tract damage
Infection
Venous thromboembolism
Anaesthetic complications
Evacuation product of conception
Indications
Elective first trimester abortion
Molar pregnancy
Retained placenta/product
Missed miscarriage
Contraindications
Untreated pelvic infection
Coagulopathy
Patient refusal
Complications
Bleeding/infection
Uterine perforation
Cervical laceration
Asherman syndrome
Oophorectomy & salphingectomy
Contraindications
Multiple previous abdominal surgeries
Suspected malignancy
Bowel obstruction
Indications
Permanent sterilisation
Hydrosalphinx
Tubal pregnancy
Blocked tube
Complications
Bleeding
Adjacent visceral injury
Chronic pain
Hysterectomy
Indications
Adenomyosis
Endometrial & cervical malignancy
Endometriosis
Chronic pelvic pain
Uterine myoma
Contraindications
Uterine size > 280 g
Ovarian malignancy
Advanced uterine/cervical malignancies
Complications
Haemorrhage
Infection
Adjacent visceral injury
DVT
Adhesions
Anaesthesic complications
Nerve damage
Ovarian cystectomy
Indications
Definitive d(x) of ovarian cysts
Removal of symptomatic cyst
Exclusion of ovarian cancer
Complications
Cyst rupture
Recurrent cyst
Risk of oophorectomy
Contraindications
Suspected malignancies
Obesity
Bowel obstruction