peri-operative care PPT

• Dilation and curettage (D&C)


  A surgical procedure to remove tissue from inside the uterus
• 3 indications for D&C

  • To diagnose a condition
  • Treat certain uterine conditions like heavy bleeding
  • Clear the lining of the uterus after an abortion or miscarriage
• Cesarean delivery (C-section)

  A surgical technique used to deliver a baby by creating an incision on the abdomen and uterus of the pregnant woman
• Reasons for lack of progress in labor leading to possible cesarean birth

  • The cervix is not dilating enough despite strong contractions over several hours and baby is not descending
  • Uterine inertia where the uterus is insufficiently contracting and relaxes during labor
  • Cephalopelvic disproportion, where the fetal head is too large to pass through the mother's pelvis or birth canal
• Dilation and curettage (D&C)


  A surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument) to remove abnormal tissues
• Cesarean Section

  A procedure used most often as a prophylactic measure to alleviate problems of birth such as cephalopelvic disproportion, breech or multiple fetus births, or failure to progress in labor
• Factors causing the increase in Caesarean Births

  • Increasing safety of cesarean birth
  • The use of fetal monitors (which provide for early detection of fetal problems)
  • An increased incidence of obese women
  • Scheduled or elective cesarean births (chosen by women for convenience or to prevent potential urinary or anal incontinence later in life)
  • The increase in rate may also be related to a health care provider's fears of malpractice suits should a fetus be allowed to be
• Diagnostic indications for D&C

  • Abnormal uterine bleeding: irregular bleeding, menorrhagia, suspected malignant or premalignant condition
  • Retained material in the endometrial cavity
  • Evaluation of intracavitary findings from imaging procedures (abnormal endometrial appearance due to suspected polyps or fibroids)
  • Evaluation and removal of retained fluid from the endometrial cavity
  • Hematometra (retention of blood in the uterus), Pyometra (pus formation in the uterus) in conjunction with evaluating the endometrial cavity and relieving cervical stenosis
  • Endometrial biopsy insufficient for diagnosis or failed due to cervical stenosis
  • Endometrial sampling in conjunction with other procedures (e.g., hysteroscopy, laparoscopy)
• Therapeutic indications for D&C

  • Removal of retained products of conception (e.g., incomplete abortion, missed abortion, septic abortion, induced pregnancy termination)
  • Suction procedures for management of uterine hemorrhage
  • Treatment and evaluation of gestational trophoblastic disease
  • Hemorrhage unresponsive to hormone therapy
  • In conjunction with endometrial ablation for histologic evaluation of the endometrium
• Indications for cesarean birth

  • Maternal factors: Active genital herpes or (perhaps) human papillomavirus, AIDS or (perhaps) HIV-positive status, Cervical cerclage, Disabling conditions, such as severe gestational hypertension, that would prevent pushing to accomplish the pelvic division of labor, Failed induction or failure to progress in labor, An obstructive benign or malignant tumor, Previous cesarean birth by classic incision, Fear of birth or wish to help prevent uterine prolapse or urinary incontinence in later years
  • Placental Factors: Placenta previa, Abruptio Placenta / Premature separation of the placenta
  • Fetal Factors: Compound conditions such as macrosomic fetus in a breech lie, Extreme low birth weight, Fetal distress, A major fetal anomaly, such as hydrocephalus, Multigestation or conjoined twins, Transverse fetal lie and perhaps breech presentation
• Classification of cesarean births based on urgency

  • Scheduled Cesarean Birth: Planned, allowing thorough preparation. Reasons include physical indication such as transverse presentation, an infection that could be contacted by the fetus if born vaginally, Cephalopelvic disproportion (CPD), to reduce mortality among infants presenting breech, advantageous for a preterm birth to avoid pressure on the fetal head
  • Emergent Cesarean Birth: Done for reasons that arise suddenly in labor, such as Placenta previa, Abruptio Placenta, Fetal distress, Failure to progress
• Pre-operative nursing assessment


  Includes a pre-op checklist, current medical diagnosis, diagnostic and laboratory test results, physical status and physiological response to surgery, cardiopulmonary clearance, spiritual needs, ethnic and cultural background, previous surgery, psychosocial status
• Cardiopulmonary Clearance


  A form which contains remarks of cardiologist and pulmonologist regarding patient's risk to intraoperative and postoperative complications based on their physical assessment, history taking and laboratory and diagnostic tests results of the patient. Categories include high risk, moderate risk, low risk, no contraindication.
• Informed Consent

  Obtaining operative consent is the primary health care provider's responsibility. The nurse may be asked to witness a woman's signature on such a form, and should ensure it was informed consent where the risks and benefits were explained in terms the client could easily understand. In the Philippines, a person 18-60 years old qualifies to be considered of legal age and can sign the consent. If the client is a minor, then the parent or legal guardian will sign the consent.
• Overall Hygiene

  On admission, provide a clean hospital gown. If a woman's hair is long, encourage her to braid it or put it into a ponytail so it will more easily fit under the surgical cap she will wear; hair contained by a cap is less likely to spread microorganisms during surgery. Follow institution's procedures.
• An emergent cesarean birth carries with it the same risks of any

  emergent surgery:

  The woman may not be a prime candidate for anesthesia

  May be psychologically unprepared for the experience

  May have a fluid and electrolyte imbalance

  Physically and emotionally exhausted from a long labor