ODOBGYNDECODED

Procedures & operative gynaecology

Pap Smear & Colposcopy office/outpatient

Open Pap Smear & Colposcopy reference →

IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Cervical screening per programme
  • Abnormal cytology/HPV-positive triage
  • Post-treatment surveillance
Consent points
  • Purpose/limitations
  • Discomfort/spotting expected
  • Follow-up pathway explained
Equipment
  • Speculum, cytobrush/spatula or HPV swab, fixative/media
  • Colposcope + acetic acid 3-5% + Lugol iodine
Anaesthesia
  • None usually; biopsy 1-2 min sting

Preparation

  • Avoid menses; no intercourse/vaginals 48 h
  • Pregnancy noted (colposcopy safe; treatment deferred)
Procedure steps
  1. Visualise SCJ fully (document type)
  2. Acetowhiting assessment + vascular patterns
  3. Directed biopsies of worst lesion
  4. ECC where transformation zone not seen/glandular concern
Complications & management
Bleeding post-biopsy

Pressure/silver nitrate; rare packing

Vasovagal

Position/reassure; recover before discharge

Postoperative care

  • Spotting advice; avoid tampons 72 h post-biopsy
Follow-up: Results appointment with defined next-step rules · Sources: CDC (USA), NHS, Médecins Sans Frontières, NICE, India MoHFW / NHM, WHO, RCOG, NICE
CDC (USA) · 2021 edition (current as of check)checkedNHS · Current NHS patient informationcheckedMédecins Sans Frontières · Current online monographcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked
IUCD Insertion (Cu-IUD / LNG-IUS) office/outpatient

Open IUCD Insertion (Cu-IUD / LNG-IUS) reference →

IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Contraception choice
  • Emergency contraception <=5 d
  • Heavy menstrual bleeding (LNG-IUS)
Consent points
  • Perforation/expulsion/malposition risks
  • Insertion pain options
  • String checks + when to call
Equipment
  • Sterile IUD kit, sound, tenaculum optional, antiseptic, uterine manipulator not needed
Anaesthesia
  • None/local gel; paracervical block selected cases

Absolute contraindications: Pregnancy · Active pelvic infection · Unexplained bleeding pending evaluation · Known GTD (LNG-IUS context) · Distorted cavity precluding placement

Preparation

  • Pregnancy excluded; STI risk assessment (screen/treat policy)
  • Analgesia NSAID 1 h prior; tenaculum-free techniques reduce vasovagal
Procedure steps
  1. Aseptic speculum + cervical antisepsis
  2. Sound cavity (gentle) unless immediate-postpartum technique
  3. Load device per type-specific instructions
  4. Insert to fundus; release; cut strings 3-4 cm
  5. Confirm placement/pain check
Troubleshooting:
  • Vasovagal: legs up/atropine readiness
  • Cannot pass cervix: misoprostol priming another day vs tenaculum+block by experienced inserter
Complications & management
Expulsion (~5%)

Check strings; reinsert if expelled early

PID risk window first 20 days

Treat PID without removal usually; remove only severe/no-response

Perforation (<0.2%)

US/laparoscopy retrieval decision; observe stable anterior-wall cases per protocol

Postoperative care

  • Return precautions card; string self-check education
Follow-up: 6-week check or symptom-driven · Sources: CDC (USA), CDC, CDC, Bayer / emc, NICE, India MoHFW / NHM, WHO, RCOG, NICE
CDC (USA) · 2021 edition (current as of check)checkedCDC · 2024checkedCDCcheckedBayer / emccheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked
Manual Vacuum Aspiration (miscarriage/abortion <=12 wks) operating theatre - gynaecology

Open Manual Vacuum Aspiration (miscarriage/abortion <=12 wks) reference →

IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Incomplete/missed miscarriage
  • Induced abortion <=10-12 wks (provider norms per MTP Rules)
  • Retained products with sepsis (post-antibiotic start)
Consent points
  • Success rates/failure -> repeat
  • Uterine perforation/infection/bleeding risks
  • Discuss gestation- and indication-specific RhD prophylaxis
  • Contraception same-day offer
Equipment
  • MVA syringe 60 mL + cannulae 4-12 mm
  • Tenaculum, sound, antiseptic, speculum
  • Histology container (molar suspicion always)
Anaesthesia
  • Paracervical block 1% lignocaine ± light sedation

Absolute contraindications: Suspected ectopic (treat as such) · Haemodynamic instability uncorrected · Molar pregnancy needs suction-evacuation setup (specialist)

Preparation

  • CBC/group&save; sepsis screen if febrile
  • Analgesia plan (paracervical block ± sedation)
Procedure steps
  1. Aseptic prep; tenaculum traction reduces pain/perforation
  2. Sound to depth; choose cannula = weeks of gestation (mm)
  3. Create vacuum ~60 mL; evacuate with rotating strokes
  4. Inspect aspirate: products complete? vesicles?
  5. Confirm uterus contracted; minimal bleed at end
Troubleshooting:
  • No tissue obtained: reconsider ectopic/retroversion error
  • Excessive bleeding: uterotonics; complete evacuation faster is haemostatic
Complications & management
Uterine perforation

Stop; observe stable small anterior perforations; laparoscopy/laparotomy for suspected visceral injury/unstable

Retained products

Repeat aspiration; antibiotics if infected

Infection/endometritis

Broad-spectrum course; sepsis pathway if systemic

Postoperative care

  • For miscarriage, use the linked NICE NG126 2026 gestation-specific RhD criteria after confirming local applicability; induced abortion has a separate guidance context
  • Analgesia + red-flag leaflet
  • hCG follow-up plan
Follow-up: 1-2 wk review or urine test at 3 wks · Contraception started same day counselling · Sources: Government of India (MoHFW), NICE, NICE, NICE, RCOG, Médecins Sans Frontières, NICE, India MoHFW / NHM, WHO, RCOG, NICE
Government of India (MoHFW) · Current law as of 2026-08-23 (no later amendment found in search)checkedNICE · NG126checkedNICE · NG126, June 2026checkedNICE · NG126checkedRCOG · Current public care informationcheckedMédecins Sans Frontières · Current online monographcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked
Intrauterine Balloon Tamponade (PPH) operating theatre - obstetric

Open Intrauterine Balloon Tamponade (PPH) reference →

IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • Atonic PPH refractory to uterotonics
  • Post-trauma bleeding after repair
  • Bridge during transfer
Consent points
  • Emergency consent documented
  • Failure -> surgery ladder explained
Equipment
  • Bakri/Rusch/Foley(+condom) kit, warm saline, infusion set, tape traction, catheter bag
  • Theatre conditions preferred
Anaesthesia
  • Existing epidural/GA ideal; can be done under analgesia in emergencies

Absolute contraindications: Ongoing surgical bleeding source (vessels/tears) · Infection unmanaged · Uterine malformation blocking placement

Preparation

  • Bladder empty; uterotonic maximised; blood running
Procedure steps
  1. Insert balloon above internal os US-guided when feasible
  2. Fill warm saline INCREMENTALLY until bleeding stops (150-500 mL typical)
  3. Document fill volume; apply modest traction tape
  4. Vaginal pack adjunct where device lacks stem
  5. Keep catheter draining bladder continuously
Troubleshooting:
  • Refills beyond ~500 mL without control = failure sign -> laparotomy promptly
  • Recurrent filling: reassess for missed trauma/coagulopathy BEFORE more volume
Complications & management
Device displacement

Traction+tape; reposition theatre if recurrent

Infection (leave <=24 h)

Single-dose antibiotic cover; timed removal with uterotonic standby

Postoperative care

  • Hourly bleeding observation x6
  • Remove 6-24 h with team ready for re-bleed
Follow-up: PPH recovery bundle; documentation audit · Sources: WHO / FIGO / ICM, MSF, NICE, India MoHFW / NHM, WHO, WHO, WHO / FIGO / ICM, RCOG, NICE
WHO / FIGO / ICM · Consolidated edition (supersedes fragmented prior guidance incl. 2012 PPH recs; incorporates 2017 TXA recs, 2018 uterotonics, 2023 blood-loss assessment/treatment bundle)summary checkedMSFcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedWHOsummary checkedWHO / FIGO / ICM · 2025 consolidated recommendations, supportive care tablesummary checkedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked
Diagnostic Hysteroscopy (+ targeted biopsy/polypectomy) operating theatre - gynaecology

Open Diagnostic Hysteroscopy (+ targeted biopsy/polypectomy) reference →

IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • AUB evaluation
  • Polyps/submucous lesions
  • Retrieved-missed IUD
  • Adhesions assessment
Consent points
  • Perforation/trail-off failures
  • Fluid-absorption risks (distension media)
  • Day-case expectations
Equipment
  • Hysteroscope +/- operating sheath, distension media pump, graspers/scissors/bipolar
  • Video tower
Anaesthesia
  • Outpatient no-anaesthetic/minimal vs GA per case

Relative contraindications: Active pelvic infection · Pregnancy · Cervical cancer suspicion (staging implications)

Preparation

  • Pregnancy exclusion
  • Timing proliferative phase or GnRH-primed for better views
Procedure steps
  1. Vaginoscopic entry (no tenaculum) where possible
  2. Systemic survey: tubal ostia->fundus->anterior/posterior/cervix
  3. Targeted biopsies/polyp morcellation
  4. Document mapping + images
Troubleshooting:
  • Poor distension: clamp leaks/check inflow pressure limits
  • Media deficit >1000-1500 mL hypotonic: stop + electrolytes watch (OHIA risk)
Complications & management
Uterine perforation

Usually managed conservatively if blunt/small; energy injuries need laparoscopy urgently

Fluid overload hyponatraemia

Stop media; diuretics/electrolytes per protocol

Postoperative care

  • Discharge same day uncomplicated; results discussion
Follow-up: Histology review clinic · Sources: CDC (USA), RCOG, RCOG, Médecins Sans Frontières, NICE, India MoHFW / NHM, WHO, NICE
CDC (USA) · 2021 edition (current as of check)checkedRCOG · Patient information based on 2024 GTG59 / 2023 GPP16checkedRCOG · Current public recovery informationcheckedMédecins Sans Frontières · Current online monographcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedNICE · CG50, recommendationschecked
Caesarean Section Core Operative Page operating theatre - obstetric

Open Caesarean Section Core Operative Page reference →

IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • See lscs module urgency framework
Consent points
  • Specific injury/transfusion/hysterectomy/future-placenta risks
  • Skin-to-skin plans where feasible
Equipment
  • Standard CS tray; head-elevation vacuum for impacted head; cell-salvage availability
Anaesthesia
  • Regional default; GA criteria list

Preparation

  • Antibiotic timing chart; neonatal team; VTE stockings; warming blanket
Procedure steps
  1. Joel-Cohen/transverse skin incision
  2. Blunt abdominal entry; bladder flap as needed
  3. Lower-segment transverse hysterotomy (avoid placenta!)
  4. Deliver head/body; cord gases
  5. Oxytocin bolus+infusion; controlled placental delivery
  6. Single-layer uterine closure; check ovaries/tubes opportunistically
  7. Counts -> layered closure; subcuticular skin
Troubleshooting:
  • Impacted head: elevation device/push-from-below
  • Praevia encountered: pas-spectrum rules
  • Angle tears: visualise ureters; extend deliberately
Complications & management
PPH

Uterotonics -> balloon/compression sutures ladder

Bladder injury

Two-layer urology repair + catheter 7-14 days

Endometritis

Triple antibiotics; wound review

Postoperative care

  • ERAS bundle: early fluids/feeding/mobilisation
  • Multimodal analgesia incl. TAP blocks
Follow-up: Wound review; next-pregnancy birth-mode counselling · Sources: NICE, NICE, NICE, India MoHFW / NHM, WHO, Médecins Sans Frontières, Médecins Sans Frontières, RCOG, NICE
NICE · NG235 (replaces CG190); updates Nov 2025 water birth, Jun 2025 fluid balance/bladder care/hyponatraemia, Jun 2026 vitamin K deficiency bleeding prevention reintroducedcheckedNICE · NG192checkedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedMédecins Sans Frontières · Current online monographcheckedMédecins Sans Frontières · Current online monographcheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked