MBARARA UNIVERSITY OF SCIENCE 

AND TECHNOLOGY

PRE AND POST OPERATIVE CARE

PRINCIPLES

Department of Obstetric and Gynecology

Prof: Ivan Bonet.

Gynecology
H.O.D
 Pre and Post Operative care Principles ………

GENERAL CONSIDERATION IN PREOPERATORY 
EVALUATION

 Preoperative evaluation should include  medical and 
surgical History.
 Complete physical examination. 

 Laboratory test.

 An anaesthesiologist routinely sees patients 
preoperatively.
 The medical evaluation  must be carried out to 
identify all disorders that might complicate the 
operative procedure.
 Records  of prior hospitalization should be obtained. 
 Pre and Post Operative care Principles ………

I E S
TUD
Y    S
TO R
R A
ABO
L
 Pre and Post Operative care Principles ………

LABORATORY TEST
  The efficacy of various preoperative testing regimens has 
not been established in a prospective.      
Most gynecologist would agree that preoperative laboratory
studies should include
 CBC
 Blood typing and antibody screen
 Urinalysis and culture
 A Papanicolou smear should also be obtained .
 Blood for typing and cross matching.
 FBS (determinations are helpful to exclude diabetes).
 Platelet count, bleeding time, Prothrombin time, and partial
thromboplastin time (evaluate the adequacy of the clotting system)
 Pre and Post Operative care Principles ………

LABORATORY TEST (Cont……)
 HIV antibodies, Hepatitis B surface antigen, serologic test for
Syphilis.
 Liver, Renal and Endocrine function testing should be obtained as
indicated.

Note:
Further laboratory tests should be performed only when indicated by
the patients medical condition or by the type of surgery to be
performed.
 Pre and Post Operative care Principles ………

LABORATORY TEST (Cont……)

Further imagining studies should be obtained only for indication or

depend of the type of the operation.
 Ultrasonography: is useful for characterization of pelvic mass.

 CT: also performs that function as well as giving information regarding

the course of the uterus.
 Magnnetic Resonance Imaging.
 Intravenous Pyelogram
 Double barium enema: can be useful in identifying bowel lesions or
colonic involvement with pelvic mass.
 Pre and Post Operative care Principles ………

NS
T A TIO
NS UL
CO
 Pre and Post Operative care Principles ………

Consultations
 Patients should be seen well seen in advanced of their surgical date
by the anesthesiologist. (this allows for the optimal selection of the
type of anesthesia.
 Consultations with others physicians should be requested if the
surgeon desires advice or assistance with a particular hight risk of
surgery candidate.
 Medical preoperatory consultation if of particular importance for the
older surgery patients as well as the younger's patient with a known
CVC, Pulmonary, Renal,, Hematologic or endocrine problem
 Consultation with Gynecologic Oncologist should be considered
preoperatively when the index of suspicion for malignancy is high.
 Pre and Post Operative care Principles ………

IA N
SI C
H Y N
 – P I O
EN T CA T
A T I N I
P MU
C O
 Pre and Post Operative care Principles ………

PATIENT – PHYSICIAN
COMUNICATION

A- Informed Consent.

B- Patient Education.

C- Documentation.
 Pre and Post Operative care Principles ………

A- Informed Consent.
It is imperative for every patient:
 To have a complete understanding of exactly what her
procedure will involve
 why is proposed.
 What other alternatives are available.
 The chances for the success.
What are the possible complications of the procedure

To document that this important interaction took place

to the satisfaction of the patient, she or her legal
guardian should consent for.

If an interpreter was used, the interpreter should sign

this document. 
 Pre and Post Operative care Principles ………

B- Patient Education.

 Audiovisual aids may be helpful in the

patient counseling process.

A well-prepared video tape with simple

diagrams can provide a consistent in depth
presentation.
 Pre and Post Operative care Principles ………

C- Documentation.

All details of the history, physical

examination and diagnostic and therapeutic
formulations and conclusions of all
preoperative consultations must be entered
in the patient’s chart.
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

1. Cardiovascular System.
a) Cardiac disease
b) Varicose Veins and history of deep Vein thrombosis.
c) Valvular heart disease.
 
2. Pulmonary System
3. Renal System
4. Hematology System.
a) Anemia
b) Thrombocytopenia

5. Endocrine System
a) Diabetes Mellitus
b) Thyroid Disease
c) Recent or current corticosteroid use
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

6. Other conditions affecting operative risk.

a) Pregnancy.

b) Age.

c) Obesity

d) Drug allergies and sensitivities.

e) Immunologic compromise.
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

1. Cardiovascular System
a) Cardiac disease: Any patient with heart disease
should be considered a high risk surgery candidate
and must be fully evaluated preoperatively with the
assistance of a cardiologist.

Special study:
 Electrocardiography
 Echocardiography
 Intraoperative central monitoring.
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

1. Cardiovascular System.
b)Varicose Veins and history of deep Vein
thrombosis: This patient have a risk for developing lower
extremity thrombophlebitis or thromboembolic phenomena.

How to minimize the risks?

 Prevention of dehydration.
 Early ambulation
 Prompt and adequate treatment of cardiac disorders.
 When discharged the patient should be advice to avoid
prolong sitting, auto, train or air travel during the first
month after surgery.

c) Valvular heart disease: Antibiotic prophylaxis should

be administered
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

2. Pulmonary System.

 Elective surgery should be postponed if acute upper

or lower respiratory tract infection is present.

 If emergency surgery is necessary in the presence of

respiratory tract infection , regional anesthesia should
be used if possible and aggressive measure should be
taken to avoid postoperative atelectasis or pneumonia.
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

3. Renal System.
Renal function should be appraised if:
 There is history of kidney disease

 Diabetes mellitus.

 Hypertension.

 Over 60 years of age.

 If routine urinalysis reveals proteinuria.

 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

4. Hematology System.
a) Anemia:

 Diagnosed in the preoperative obstetric or gynecologic

patient usually is of the iron deficiency type caused by
inadequate diet, chronic blood loss, or chronic disease.

 The diagnosis of obscure anemias may require the help

of a hematologic consultation.

 In emergencies or urgent cases, preoperative blood

transfusions, preferable with packed red cells, may be
given.
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

4. Hematology System.
b) Thrombocytopenia:
 The normal Platelet count ranges from 150 000 to 350
000/uL.

 In the patient with thrombocytopenia but normal capillary

function, platelet deficiency begins to manifest clinicaly as the
count falls below 100 000/uL.

 Hypermenorrhea may be severe enough to require

transfusion.

 The thrombocytopenic patient may require transfusion of

platelets before surgery if the platelet count falls too low.

 Spontaneous hemostasis is not expected if the platelet

 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

5. Endocrine System
a) Diabetes Mellitus:

 Fasting plasma glucose should be determined prior to

surgery.

 diabetic whose is out of control are especially susceptible

to postoperatory sepsis.

Therefore, it is important to avoid hypoglycemia by closely

monitoring blood sugar the day of surgery.

If the diabetes is severe is necessary to admit the patient

to the hospital before the operation for glycemic control.
 Pre and Post Operative care Principles ………

ASSESSMENT AND MINIMIZATION OF SURGERY RISK

5. Endocrine System
b) Thyroid Disease:
 Elective surgery should be postponed when thyroid
function is suspected of being either excessive or
inadequate.
 The patient should be rendered euthyroid before surgery
if possible.

c) Recent or current corticosteroid use:

 Patient who are taking corticosteroids, or have
recently stopped them are not able to respond to the
stress of surgery appropriately.
 Hydrocortisone 100 mg three times a day on the
day of surgery, 100 mg twice a day on postoperative
day 1, and 100 mg on postoperative day 2.
 Pre and Post Operative care Principles ………

PREOPERATORY ORDERS

A- Skin preparation
B- Diet
C- Preparation of the gastrointestinal tract.
D- Sedation
E- Preanesthetic Medication.
F- Other Medication.
G- Antibiotics.
H- Blood Transfusions.
I- Bladder preparation.
J- Douches.
 Pre and Post Operative care Principles ………

POSTOPERATIVE CARE
POSTOPERATIVE CARE

IMMEDIATE POSTOPERATIVE CARE:

 Maintenance normal pulmonary and circulatory
function should be emphasized.

 Vital signs and fluid balance should be monitored

frequently to facilitate the early signs of shock or
pulmonary problems.

 Bleeding for the surgical site.

 persisting pulmonary or cardiovascular effects from

anesthesia.
 Pre and Post Operative care Principles ………

POSTOPERATIVE ORDERS
POSTOPERATIVE ORDERS

A- Vital signs F- Intake and output

B- Wound Care G- Fluid Replacement

C- Medications H- Diet

E- Drainage tubes I- Respiratory Care

D- Position in Bed J- Ambulation

 Pre and Post Operative care Principles ………

POSTOPERATIVE ORDERS
POSTOPERATIVE ORDERS
A­ Vital signs:
-BP, Pulse, RR: every 15 – 30 mts until to stable then hourly for 
4 to 6 hours.
- Then 4 time daily for operatory course
- Report any change.

B­ Wound care:
-Watch for excessive bleeding (repet hematocrit)
-Abdominal wound should be expected daily.
- Skin sutures general removed after 5 – 7 days postoperatory. 

C­ Medicationts:
-Analgesic (meperidine 75 – 100 mg im o Morphine 10 mg im 
every 4 hours.
- Non­steroidal anti­inflammatory (for postoperatory pain 
control)
- Antiemetics (promethazine) 
 Pre and Post Operative care Principles ………

POSTOPERATIVE ORDERS
POSTOPERATIVE ORDERS
D­ Position in bed:
-Usually on her side to reduce the risk of inhalation of vomitus.

E­ Drainage tubes:
-Connect bladder catheter
- Other drainage.

F­ Intake and output:
-Record intake and output of all fluids as well as daily weight

G­ Fluid replacement:
-Take into account factors such as ( intraoperatory blood loss, 
urine out, operating time, Intraoperative fluid replacement, 
amount of fluid received in the recovery area)
- Normally 2400 ml to 3 L of crystalloid and glucose 5% is 
necessary in 24 hours
 Pre and Post Operative care Principles ………

POSTOPERATIVE ORDERS
POSTOPERATIVE ORDERS
H­ Diet:
-Must be individualized to the patient and depends on many 
factors.
  . Do not give ice water because it may decrease bowel motility 
significantly.
  . Clear liquids if good bowel sound are noted and until 
intestinal gas is passed.
  . The time needed to progress to a full diet depends on the 
extent of the procedure, duration of anesthesia. 

I­ Respiratory care:
-Encourage deep breathing every hours for the first 12 hours and 
every 2­3 hours for the next 12 hours. 

I­ Ambulation:
-Encourage early ambulation and bathroom privileges.
 Pre and Post Operative care Principles ………

RECOVERY FROM MAJOR SURGERY

The patient generally remains
hospitalized until recovery of all bodily
functions.
Normal pulmonary function usually
returns after resolution of inhalation
anesthesia
Two or three days may pass before return
of normal bowel function after laparatomy

The patient will febrile complications

generally will not be discharged until she has
remained asymptomatic and febrile for 24
hours.