Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Basic Obstetrics and Obstetric Surgery in a Mission Setting
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3. There may be many large and dilated veins. You may compress these to
drain them, which may help you to avoid lacerating them.
4. You will need to employ more clamps as you work down the sides of the
uterus and cervix as compared to a nonpregnant uterus.
5. The ureters will be dilated by pregnancy and more difficult to palpate.
6. The cervix will most likely be effaced, and thus special care needs be taken
to ensure that you have excised the cervix and created a vaginal cuff.
Suggested Reading
1. B-Lynch, CA. Coker AH. Lawal et al. The B-Lynch surgical technique for the
control of massive postpartum hemorrhage: An alternative to hysterectomy? Five
cases reported. Brit J. Obstet Gynaecol 1997; 104:372-375.
2. Bruner JP, Drummond SB, Meenan AL, Gaskin IM. All-fours maneuver for reducing
shoulder dystocia during labor. J Reprod Med 1998; 43:439-443.
3. Gonik BA, CA Stringer, B Held. An alternate maneuver for management of shoulder
dystocia. Am J Obstet Gynecol 1983; 145:882.
4. Hartfield VJ. Symphysiotomy for shoulder dystocia. Am J Obstet Gynecol 1986;
155:228.
5. King M et al. Primary Surgery. Oxford Medical Publications.
6. Mayo Clinic Manual of Pelvic Surgery. 2nd ed. 2000. Webb M, ed. Lippincott
Williams & Wilkins.
7. Obstetrics, Gynecology & Infertility. Revised 4th ed. Scrub Hill Press, 1997
8. Russell JGB. The Rationale of Primitive Delivery Positions. Br J Obstet Gynaecol
1982; 89:712.
9. Van Vugt PJH, Baudoin P, Bloom VM, Duersen TBM. Inversio uteri puerperalis.
Acta Obstet Gynecol Scand 1981; 60:353.
10. Wheeless CR. Atlas of Pelvic Surgery. 3rd ed. Williams Obstetrics. 20th ed. Appleton
& Lange: Williams & Wilkins, 1997.
11. Woods CE. A principle of physics is applicable to shoulder delivery. Am J Obstet
Gynecol 1943; 45:796.
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