Gynecological Operation and Nursing Management

Gynecological Operation and Nursing
Management
Abdominal hysterectomy
Vaginal hysterectomy
Presented By: Hawra Nasser ALsaad

Supervised By: Dr. Reem Alghamdi
NUR 586
• Abdominal Hysterectomy
• Types of Abdominal Hysterectomy
• Indication of abdominal Hysterectomy
• Preoperative preparation for hysterectomy
• Steps of abdominal hysterectomy
• Postoperative Care after Hysterectomy
• Postoperative complication
• Vaginal Hysterectomy
• Postoperative care
• Complication of vaginal hysterectomy
• Nursing Management
Definition
A hysterectomy is an operation to remove the uterus. This surgery may be
done for different reasons.
Incidence
An abdominal hysterectomy carries an increase morbidity compared with
vaginal hysterectomy.
Types of Hysterectomy
• Subtotal hysterectomy
removes only the upper part of the uterus, keeping the cervix in place.
• A total hysterectomy
removes the whole uterus and cervix.
• A radical hysterectomy
removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the
vagina. Radical hysterectomy is generally only done when cancer is present.
Indication for abdominal hysterectomy

• Fibroid uterus
• Dysfunctional uterine bleeding
• Endometriosis
• Pelvic inflammatory disease
• Malignancies of genital tract
• Sever postpartum hemorrhage
Preoperative preparations for hysterectomy

• A complete history and physical examination such as hypertension, cardiac disease, diabetes or
asthma.
• Use of medication such as aspire, oral homoglycans, heparin, oral warfarin should be document.
• Biopsy of the endometrium.
• PAP smears to rule out of cervical cancer.
• CBC count
• ECG and Chest radiograph
Choice of Incision
Incision for abdominal hysterectomy may be
• Supraumbilical midline
• Suprapubic transverse incision
• Midline incision
The steps for a simple total hysterectomy, after the abdomen is opened are as
follows:
• The round ligaments are divided.
• If the tubes and ovaries are to be removed, the infundibulopelvic ligaments are ligated and
tied (the ureters should be identified first).
• The uterovesical peritoneal fold is divided and the bladder reflected down past the cervix.
• The parametrial tissue is divided.
The steps for a simple total hysterectomy, after the abdomen is opened are as
follows:
• The uterine vessels and ligated and tied.
• The paracervical tissue and uterosacral ligaments are ligated and tied.
• The vagina is opened and the uterus and cervix removed.
• The vagina is usually closed with an absorbable suture.
• Haemostasis is confirmed at all pedicles.
• The abdomen is closed.
Abdominal Hysterectomy
Postoperative complication
• Hemorrhage
• Postoperative fever
• Urinary tract injury
• Wound dehiscence and infection
• Bowel injury
• Deep venous thrombosis
Vaginal Hysterectomy
Definition :Vaginal hysterectomy is a surgical procedure to remove the uterus

through the vagina.
Vaginal Hysterectomy
Indications
• Heavy menstrual bleeding
• Pelvic pain
• Uterine prolapse (vaginal hysterectomy)
• Gynaecological malignancy (usually ovarian, uterine or cervical)
• Risk reducing surgery, usually in cases of BRCA 1 or 2 mutations, or Lynch syndrome.
• Hysterectomy may also be performed as a life saving procedure in the management
of major postpartum haemorrhage.
Vaginal Hysterectomy Technique
Vaginal hysterectomy
Complication
• Haemorrhage
• Postoperative fever
• Urinary tract injury
• Psychological response to surgery.
• Complication of general anaesthesia.
• Risks from blood transfusion.
Pre-Operative Nursing Care for Hysterectomy
Hysterectomy Pre-Operative Nursing Assessment

• Start by having a chat with your patient to establish a safe and therapeutic relationship. While having the
conversation, make sure to ask specific questions that will explain your patient’s situation. So, ask her:
• How she feels about the diagnosis
• Whether she knows how the surgery works, and why it’s being done
• If she is coping with it
• Whether she needs any psychological or emotional support
• If she has a relative or friend who can support her
• Is she experiencing any pain or discomfort
• During the nursing assessment you should also obtain a full medical and family history of your patient, as
well as baseline vital signs.
Pre- Operative Nursing Diagnosis for Hysterectomy

• Having finished the conversation, you can now build your nursing diagnosis, and
you’ll most likely find the following:
• Lack of knowledge about the surgery
• Stress caused by the diagnosis
• Fear from having the surgery
• Anxiety related to loss of femininity or childbearing potential
• Concern about sexual function
Hysterectomy Pre-operative Nursing Interventions

• Education about Hysterectomy
• Managing Anxiety & Fear
• Preparation on the Day of Surgery
Post-Operative Nursing Care for Hysterectomy
Post Hysterectomy Nursing Assessment

• Vital signs
• Circulation in her hands and feet
• Incision site (look out for swelling, bleeding, redness)
• The drain (volume and colour)
• The urine catheter (volume and colour)
Post-Operative Nursing Care for Hysterectomy
Post Hysterectomy Nursing Diagnosis

• The nursing assessment is likely to highlight the following nursing
diagnoses:
• Acute pain and discomfort
• Disturbed Body Image
• Struggles with Activities of Daily Living
• Sexual dysfunction
Post-Operative Nursing Care for
Hysterectomy
Post Hysterectomy Nursing Interventions

• Relieving Pain and Discomfort
• Coping with body image
Emergency Peripartum Hysterectomy in a Tertiary Care Hospital in Saudi Arabia
• Objective
• Post-partum haemorrhage remains an important cause of significant maternal morbidity and mortality
throughout the world. The objective of this study was to review the incidence, indications, predisposing
factors, and associated complications of emergency peripartum hysterectomy.
• Methods
This is a retrospective observational study done in a Tertiary Care Center, Riyadh, Saudi Arabia, between 1983
and 2006. Women who underwent emergency peripartum hysterectomy after cesarean delivery or following
vaginal birth due to severe post-partum hemorrhage who did not respond to conservative treatment were included
in the study. Data were abstracted from chart reviews. Descriptive analysis was carried out to summarize relevant
variables. Primary outcomes included indications, risk factors, maternal morbidity, and mortality.
Results
• There were 66 emergency peripartum hysterectomies among 155,857 deliveries, which
yielded an incidence of 0.04 %. Prior cesarean delivery was present in 88 % of the
patients; a majority of the patients were grandmultiparous, Para > 6 (65 %). The
incidence of hysterectomy after cesarean delivery was much higher than after vaginal
delivery (0.3 vs. 0.01 %). Common indications included placenta accreta (65 %),
uterine atony (27 %), and uterine rupture (8 %). The majority of the study cohort
(64 %) had undergone total hysterectomy. Post-operatively, 25 patients (38 %)
developed DIC, 32 (48.5 %) had febrile illnesses, and 22 (33 %) experienced injury to
the urinary tract. The maternal mortality in this study was 4.5 %.
Conclusions
• Hysterectomy for the control of obstetric haemorrhage is usually associated with
significant mortality and morbidity. Prompt intervention to include peripartum
hysterectomy may likely decrease the rate of maternal deaths and significant maternal
morbidity.
References
Rafique, N., & Al‐Sheikh, M. H. (2018). Prevalence of primary dysmenorrhea and its
relationship with body mass index. Journal of Obstetrics and Gynaecology Research, 44(9),
1773-1778.
Rafique, N., & Al-Sheikh, M. H. (2018). Prevalence of menstrual problems and their
association with psychological stress in young female students studying health
sciences. Saudi medical journal, 39(1), 67.
Ricci, S. (2020). Essentials of maternity, newborn, and women’s health. Lippincott Williams &
Wilkins.

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Gynecological Operation and Nursing Management

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Gynecological Operation and Nursing

Presented By: Hawra Nasser ALsaad

Indication for abdominal hysterectomy

Preoperative preparations for hysterectomy

Definition :Vaginal hysterectomy is a surgical procedure to remove the uterus

Hysterectomy Pre-Operative Nursing Assessment

Pre- Operative Nursing Diagnosis for Hysterectomy

Hysterectomy Pre-operative Nursing Interventions

Post Hysterectomy Nursing Assessment

Post Hysterectomy Nursing Diagnosis

Post Hysterectomy Nursing Interventions

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