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In the last decade, laparoscopic surgery had become popular in gynaecological surgery. Advantages of the minimally invasive approach are reduced postoperative morbidity, less postoperative pain and, consequently, less analgesic requirement, early resumption of intestinal activity and reduced length of hospital stay. Ectopic pregnancy occurs in approximately 1–2% of pregnancies and the incidence is increasing. The most common site of ectopic pregnancy is the ampullary tubal portion and less frequently other parts of the tube and uterus (cornual and caesarean scar pregnancy), the cervix, the ovary and the abdominal cavity are affected. All variants of extrauterine pregnancy can be treated by a minimally invasive approach in the majority of cases. Moreover, minimally invasive surgery can be considered the standard therapeutic option for adnexal masses which represent one of the most common gynaecological diseases. In this chapter, we describe the main surgical techniques concerning these two pathologies, which are of great interest for daily gynaecological practice.
In order to optimize a patient for any gynaecological procedure, a plan for preoperative and postoperative care must be put in place. This ensures that an individualized approach is implemented in which patients are appropriately counselled prior to surgery regarding their specific risks; all medical issues are taken into account; and the surgery is carried out safely with all team members being aware of and able to plan for anticipated issues. In terms of postoperative management, a detailed plan with consideration of pain relief, fluid balance, mobilization and thromboprophylaxis will reduce perioperative morbidity and identify and treat any potential complications. Consideration of all the above factors is necessary to achieve a successful procedure for the patient, safe and timely discharge from the hospital and good patient satisfaction [1].
Maternal collapse is an acute event involving the cardiorespiratory system and/or brain, resulting in a reduced or absent consciousness level (and potentially death), in the immediate period following delivery and up to 6 weeks after delivery. The use of an Early Warning Score system modified for pregnancy (MEOWS) is being encouraged for early recognition of acutely unwell women. Circulatory arrest is diagnosed by absence of a palpable carotid or femoral pulse and resuscitation with external chest compressions should be commenced immediately. Circulatory collapse secondary to haemorrhagic shock is one of the leading causes of postpartum collapse. Glasgow Coma Scale can be used as an objective assessment of patient's level of consciousness. Automated external defibrillators or external monitors to assess cardiac rhythm should be applied as per advanced life-support guideline. Early involvement of relevant specialists should be encouraged to maintain high standards of care and reduced maternal morbidity and mortality.
Fire drill programmes using simulation of patients and clinical scenarios are useful for training doctors, midwives and allied staff to manage critical emergencies effectively. Umbilical cord prolapse, shoulder dystocia, obstetric haemorrhage, eclampsia and undiagnosed vaginal breech, sudden postpartum maternal collapse, unexpected poor neonatal outcome are some key areas where fire drills can be used. Fire drill sessions provide an environment where algorithms and management guidelines can be discussed, revised and improved. An example of a labour ward fire drill in an 'all-resource' setting with shoulder dystocia as a scenario is described. Pendleton's principles provide a structured interactive approach of giving feedback. Fire drill sessions provide an environment in which protocols and guidelines can be reviewed and revised and helps identify and rectify organisational or system factors that may contribute to poor outcome during an obstetric emergency.
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