CAESAREAN SECTION POSTOPERATIVE

MANAGEMENT WITH
REPAIR OF BLADDER
NOORSALINNA BT MOHAMED
R00616
WARD 2B

PATIENT DEMOGRAPHIC
DATA
Name

: MRS LAU YAN TING

Date Of Birth : 2 Jan 1974

Gender

: Female

Marital Status : Married

Main Language

: Malay & English

Date of Admission :6 November 2014

Date Discharged :8 November 2014
Age

:40 years

Race :Chinese
Religion :Buddhist

Past history
Past Obstetric History

Medical History

1) Baby Boy - 3.04kg

2) Baby Girl - 2.79kg
3) Baby Girl - 2.64kg

NIL

Surgical History

Family History

1) LSCS 2007
2) LSCS -2010
3) LSCS -2012

NIL

CURRENT HOSPITALIZATION
Reason

For Admission

. Patient G4P3 at 38 week of

previous scar has been decided for
elective lower segment caesarean
section operation due to horoscopic
at 6 jan 2014.

ASSESMENT UPON ADMISSION

Admitted from A&E, wheel in to ward 2B via wheel chair accompanied by

husband.

Patients alert and orientated.

Vital signs checked with BP: 114/60mmhg , pulse : 80bpm,

Respiration : 19/ min, Temperature : 36 celcius ,
weight : 82kg ,Height : 156cm.

No allergy to medication or food

Normal on speech, vision and hearing.

Breathing pattern normal, breath sound is clear

Normal mouth and throat.

Good of appetite.

No disturbance of sleeping pattern.

No contraction, CTG normal.

ON OPERATIVE DAY

Fetched patient from ot via bed, post LSCS with repair of bladder due to bladder
laceration, anaesthesia under spinal .

General condition alert and conscious.

On arrival IVD Pitocin 40units in 500mls sterofundin inprogress.

IV line patern. No swelling noted.

Operation site at lower abdomen intact with blood stain seen.

CBD 22Fr 3way inplaced with 2nd bag 3000mls irrigation of N/saline running well.

Pad checked,1 and pad soaked,fresh blood seen .pad changed,swabbing done.

Review by midwife, uterus contracted,above umbilical. pv bleeding with fresh blood noted.

Vital sign checked,Temp:36 BP:110/60mmhg Pulse 100/min Resp 21/min.

pain score 2/10.
Checked pad after 30min,heavy bleeding with 2 pad soaked of fresh blood.
pad changed,swabbing done.
Patient look pale, no complaint of drowsy.No sign and symptom of
postpartum haemorrghae (PPH).
Inform doct regarding patients condition,phone oder:
-IV Pitocin 40 units in 500 mls N/saline run at 4hours stat.
-after 30min checked pad,if still active bleeding
-IV Durotocin 1mls stat.
After 1 hours pad checked,no active bleeding ,blood stained seen.
Patient CRIB.

Indications
Possible indications include:
Cephalopelvic disproportion (use of pelvimetry is not
advised).
Malpresentation, eg breech, transverse lie.
Multiple pregnancy.
Severe hypertensive disease in pregnancy.
Fetal conditions: distress, iso-immunisation, very low
birthweight.
Failed induction of labour.
Repeat Caesarean section: two sections nearly always
means subsequent births should also be by Caesarean
section.
Pelvic cyst or fibroid.
Maternal infection, eg herpes, HIV.

COMPLICATION Repeat Caesarean section.

Women who have had up to and including four Caesarean
sections should be advised that the risk of fever, bladder
injuries and surgical injuries does not vary with planned
mode of birth. The risk of uterine rupture, although
higher for planned vaginal birth, is rare. Therefore the
decision about mode of birth after a previous Caesarean
section should take .

What are the risks of having a caesarean?

Pain
You will feel pain for a while after the operation, and
will take longer to recover than if you'd had a vaginal
birth. You'll probably feel pain in your wound and
discomfort in your tummy for a few weeks after the
operation, while your body heals (RCOG 2009).
You will be given drugs to reduce the pain, but it will
affect your day-to-day activities for some time (NCCWCH
2011, RCOG 2009).
Infection
Before you go into surgery, you'll have a single dose of
antibiotics, to reduce the risk of infection (NCCWCH
2011). Despite this, it's common for women to have an
infection after a caesarean (NCCWCH 2011, Wloch et al
2012).

Tell your midwife if you have heavy bleeding, irregular

bleeding, smelly discharge or a fever. These can be
symptoms of infection (French and Smaill 2004).
The three main infections are:
Infection in your wound. Signs include redness and
discharge, worsening pain in the wound and separation
of the wound (NCCWCH 2011). This happens to about one
in ten women, even after having antibiotics at the time
of surgery. It's more likely to happen if you have diabetes
or are overweight or obese (Wloch C et al 2012).
Infection of the lining of your uterus (endometritis). This
is more likely to happen if your waters broke before
labour started, or if you had lots of vaginal examinations
before your caesarean.
Urinary tract infection. The thin tube (catheter) inserted
during the operation to empty your bladder can cause
infection. You may find that weeing is difficult, painful,
and causes a burning sensation.

POST OPERATIVE ORDERS

GYNAECOLOGYST
-NBM for 4 hours then c/fluid.

UROLOGYST
-On CBD 22Fr 3way with continuous
N/saline irrigation.

-N/fluid if no vomiting can soft diet.

-Beware not to distend the bladder.
-Hourly v/sign for 8hours then 4hourly
-keep CBD all the time.
-strictly i/o chart.
-Irrigation chart/observe urine output.
-pad chart.
-keep CBD for 14days.
-I/V Sulperazon 1Gram BD.
-Tab. Zantac 150 Gram BD.
-Tab pcm 1 Gram TDS.
-cap.ponstan 500 Gram TDS.

PRE-OPERATIVE
1)

Correct patient / ID band in position.

2)

Consented for surgery

3)

Last meal and drink at 5/11/14 @ 2300

4)

Shaving

5)

All must be removed (jewellery, cutex etc)

6)

Vital sign checked

7)

Advice Patient to passed urine

8)

Explanation/emotional support.