Cs With BTL
Cs With BTL
Cs With BTL
OBJECTIVES
General Objective:
At the end of the one hour case presentation, the presenter and the audience will establish full
Specific Objectives:
At the end of the one and half hour case presentation, the presenter and the audience will be able to:
3. Discuss the preoperative, intraoperative and post-operative care of case being presented.
Definition
Bilateral Tubal Ligation is a surgical procedure that permanently prevents pregnancy. It is also casually
known as “getting your tubes tied,” and involves the cutting or blocking off of the fallopian
tubes. This stops the egg from traveling from the ovary to the uterus so fertilization and
implantation cannot occur. Tubal ligation can be done at any time, including after childbirth or in
combination with another abdominal surgery, such as a C-section. A cesarean delivery also
known as a C-section or cesarean section is the surgical delivery of a baby. It involves one
The absolute indications are comparatively simple: a contracted pelvis, with a conjugate at the
brim of less than 7 cm., or with other measurements so small that delivery could be accomplished in no
other way; complete obstruction of the pelvic canal by a fibroid tumor, ovarian cyst or tumor of the
sacrum; a gigantic child, whose head will not engage in the pelvic inlet and whose anterior parietal
eminence projects well beyond the symphysis. The primary indication for tubal ligation is the desire for
permanent sterilization. Those who have completed childbearing and desire a non-reversible
contraceptive option are candidates for tubal ligation. Removal of the Fallopian tubes, or salpingectomy,
has been advocated as a method for the prevention of ovarian cancer. The surgeon can perform
bilateral salpingectomy alone is not the recommendation for risk reduction in patients with a high risk of
Types of surgery:
Tubal ligations can be performed in a few different ways. In determining the right method
for you, your doctor will (in advance) consider factors such as your body weight, any previous
abdominal surgery, and whether you will be having the procedure immediately following a
vaginal birth, C-section, or other surgery.
Laparoscopic sterilization is done if you have not just given birth. For a laparoscopic
tubal ligation, the surgeon makes an incision in the lower abdomen and possibly a
second small incision in or near the naval. A laparoscope (a small, telescope-like
instrument with a light) is then inserted through the incision. The fallopian tubes are
closed up by either cutting and sealing them, clamping them, or removing them entirely.
The laparoscope is then withdrawn and the incisions are closed with stitches or special
tape
Preoperative preparation
Guidelines recommend a minimum preoperative fasting time of at least 2 hours from
clear liquids, 6 hours from a light meal, and 8 hours from a regular meal. However,
patients are usually asked not to eat anything for 12 hours prior to the procedure.
Before anesthesia, the surgeon should evaluate the site of the intended skin incision. The
intended area need not be shaved automatically unless the hair will interfere with
reapproximation of the skin edges. If the hair is to be removed, it should be clipped immediately
before surgery. Shaving appears to be associated with a slightly increased risk for infection. The
use of chlorohexidine solution rather than a povidone iodine solution is associated with a
decrease risk of both superficial and deep wound infection.
Diagnostics
Preoperative:
Imaging studies.
In labor and delivery, document fetal position and estimated fetal weight. Although
ultrasonography (ultrasound) is commonly used to estimate fetal weight, a prospective study
reported the sensitivity of clinical and ultrasonographic prediction of macrosomia, respectively,
as 68% and 58%.
Intraoperative:
Most commonly, there are no laboratory tests done intraoperatively unless much heavy
bleeding is documented. In some cases if the patient went to eclampsia.
Postoperative:
Complete blood count if necessary or requested in cases of blood transfusion during
surgery.
Anesthesia
Epidural Anesthesia
• Epidural block is achieved by introduction of an anesthetic agent into the epidural
space (entered by a needle at a thoracic, lumbar, sacral, or caudal interspace).
• Provide a blockage of the autonomic nerves and hypotension can result.
• Respiratory muscles are affected, respiratory depression or paralysis may occur if the
level of block is too high.
• Caudal Anesthesia – produced by injection of the local anesthetic into the caudal or
sacral canal. This is a variation of epidural anesthesia. This method is commonly used
with obstetric clients.
POSITION:
During caesarean section mothers can be in different positions. Theatre tables could be
tilted laterally, upwards, downwards or flexed and wedges or cushions could be used.
There is no consensus on the best positioning at present.
Most commonly, in this surgical procedure the position used is supine. Some tilt the
operating table 15 degrees to the left to reduce compression on the major vessels, yet
this has no conclusive evidence in this practice.
PROCEDURE:
Informed Consent
• A legal document that signifies that the client has been told about and understands all aspects
of as specific invasive procedure.
• Guards the client against unwanted invasive procedures
• Protects the health care facility and health care professionals when the client denies
understanding about the procedure
• Physician’s responsibility to provide appropriate information,
• Nurse’s duty to ask the client to sign the consent form, and may be a witness to the client’s
signature
POSTOPERATIVE PHASE
GOAL:
To assist an uncomplicated return to safe physiologic function after an anesthetic procedure
by providing safe, knowledgeable, individualized nursing care for clients and their family
members in the immediate post-anesthesia phase.
Immediate Assessment
– Supporting vital physiologic functions until the effect of anesthetic agents abate.
– Proper positioning of a sedated, unconscious or semiconscious client ensuring airway patency.
Incision Types
Vertical. Also known as a “classical” C-section, this cut is down the middle of the
abdomen, usually from below the navel to the pubic hair line.
Horizontal. A low-transverse incision (or a “bikini cut”) is used in 95 percent of C-
sections today. That’s because it’s done across the lowest part of the uterus, which is
thinner ,meaning less bleeding .The doctor makes an incision from one side of the
abdomen to the other, just above the pubic hair line.
Non-absorbable staples
Absorbable subticular
Contraindication:
Ambivalent patients,
Lack of finances,
Very young age,
Incapable of making a medical decision,
Presence of gynecological malignancy,
Morbidly obese patients.
Complication:
Mortality is low and about 0.01% to 0.02% and mostly related to general anesthesia.
Conversion to open laparotomy
Bowel injury from trocar, electrocautery
Vascular injury from trocar
Ectopic pregnancy
Vascular injury
Failure to sterile because of lack of anatomical knowledge, failure to identify oviduct, poor
technique
Pain
Infection
Patient regret
Postoperative Mangement
Activity:
1. Bed rest
2. Supine for 8 hours after spinal anesthetic
3. Incentive Spirometry every 1 hour while awake
Standard Diet
Intravenous fluids
Medications
Nausea
Initial Analgesia
Later analgesia
Other Medications
Richardson Retractor w/ Loop Handle, medium 1-1/4″ (3.2cm) x 1″ (2.5cm), 9-1/2″ (23.8cm)
Scalpel Handle #3 Graduated CM’s – for blade sizes #10-15
Nursing Diagnosis
Preoperative
Deficit knowledge related to unfamiliar surgical experience.
Anxiety/fear related to pain, death, disfigurement, or the unknown
Post operative
Initial Nursing Diagnoses
Impaired skin integrity related to invasive procedure, immobilization, and altered
metabolic and circulatory state.
Risk for fluid volume deficit related to blood loss, food and fluid deprivation, vomiting,
and indwelling tubes.
Pain related to surgical incision and tissue trauma.
DISCHARGE PLAN
Do not take long baths, soak in a hot tub, or go swimming until your skin has
healed.
Avoid heavy exercise for several days after the procedure. Try not to lift
anything heavier than 10 pounds (about a gallon, 5 kg, jug of milk).
Prolonged sitting and standing.
Don’t have sexual intercourse until after you’ve had a checkup with
your healthcare provider.
2. Treatments/Therapies
a. Yoga
b. Meditation
c. Breathing exercises
3. Health Teaching/Education
Health Prevention/Promotion
4. Diet
a. Prescribed Diet: High protein, minerals and calcium rich food
Diet Restrictions:
Avoid food items that cause gas and constipation. Avoid consumption of junk
food and carbonated drinks and consume food items such as soup, cottage
cheese, broth, yoghurt and other items which are easily digested by the body.
Prognosis
The risk of professional liability for operative complications is increased with this
procedure. This risk is low, but real. Furthermore, sterilization failure occurs in about 1 in 100
https://www.statpearls.com/ArticleLibrary/viewarticle/30649
https://www.germedusa.com/p-3196-vaginal-tubal-ligation-instrument-set.aspx
https://www.ncbi.nlm.nih.gov/books/NBK549873/
https://www.clinicalpainadvisor.com/home/decision-support-in-
medicine/anesthesiology/postpartum-tubal-ligation/
https://emedicine.medscape.com/article/263424-overview#a1
https://www.medscape.com/answers/263424-184943/how-is-the-site-of-the-incision-prepared-
prior-to-cesarean-delivery-c-section
https://medlineplus.gov/ency/patientinstructions/000620.htm
https://www.lybrate.com/topic/diet-after-c-section
https://www.fairview.org/patient-education/86307
https://reference.medscape.com/drug/ceftin-zinacef-cefuroxime-342500