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Post-Operative Care: LSCS & Hysterectomy

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A. Post-Operative Care After LSCS (Lower Segment Caesarean Section)

Immediate Recovery (First Few Hours)

First 24 Hours

• Pain control: PCA pump if available × 24 hrs; if not tolerating PO — morphine 2 mg IV q6h PRN; if tolerating PO — oxycodone/acetaminophen (Percocet) 1–2 tabs q4h PRN or hydromorphone 2 mg PO q4h PRN
• Diet: Clear liquids; advance as tolerated
• Activity: Out of bed with assistance; ambulation encouraged
• Uterine cramping: Expected; patient to be informed
• Breastfeeding: Initiate as early as possible; lactation consult PRN
• IV line: Maintain IV access

Medications to Have Ready

First Postoperative Day

• Ambulate to prevent atelectasis and pneumonia
• Advance diet if bowel sounds present (clear → full liquids → regular)
• Remove Foley if ambulating well
• Switch IV to heparin lock
• Transition to oral analgesia
• Monitor: diuresis (postpartum diuresis expected), flatus
• Labs: CBC in AM

Call Clinician If:

• Temperature >100.4°F (38°C)
• Pulse >110 bpm
• Increasing uterine tenderness
• Foul-smelling lochia
• Excessive vaginal bleeding

Second Postoperative Day / Discharge Criteria

• Tolerates regular diet
• Bowel movement passed
• Afebrile
• Ambulating on oral analgesics only
• Many patients can be discharged 36 hours after caesarean

Wound Care

• Keep wound clean and dry
• Avoid coverage by skin folds (prevents moisture/infection)
• If staples present: remove and replace with Steri-Strips; if not done by day 2, do at postoperative day 5 as outpatient
• Follow-up wound check at 1 week

Discharge Instructions

• No driving for 10 days
• No intercourse for 4–6 weeks
• Limit activity to walking for first week; full activity by 6 weeks
• Notify physician for: wound discharge/pus, fever, dysuria, dyspnoea, or worsening pain
• Sitz bath 3–4 times daily PRN for perineal discomfort or haemorrhoids

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B. Post-Operative Care After Hysterectomy

General Postoperative Principles

1. Vital signs monitoring — standard post-surgical frequency
2. IV fluids — maintain until tolerating oral intake
3. Analgesia — multimodal preferred:
   • Epidural or spinal for laparotomy
   • IV opioids → transition to oral
   • NSAIDs + paracetamol as adjuncts
4. Foley catheter — removed early (24–48 hrs) to reduce UTI risk; ensure adequate voiding before removal
5. Ambulation — early ambulation on postoperative day 1 to reduce DVT risk and facilitate bowel recovery
6. Diet — advance from nil by mouth → clear liquids → regular diet as tolerated; laparoscopic route allows faster advancement

Respiratory Care

• Deep breathing exercises and incentive spirometry post-anaesthesia
• Early ambulation reduces atelectasis risk
• Particularly important after abdominal hysterectomy under general anaesthesia

DVT Prophylaxis

• Mechanical: TED stockings, intermittent pneumatic compression devices
• Pharmacological: Low-molecular-weight heparin (LMWH) — especially for abdominal route and prolonged surgical time
• Ambulate early

Wound Care (Abdominal Hysterectomy)

• Inspect wound daily for redness, swelling, discharge
• Drain management if placed intraoperatively
• Staple/suture removal at day 5–7 (outpatient if early discharge)

Bladder and Bowel

• Monitor urine output and colour; haematuria may occur in first 24 hrs — should clear
• Bowel sounds return earlier with laparoscopic vs. abdominal approach
• Start oral laxatives or stool softeners early (docusate, lactulose)
• First bowel movement expected day 2–4 for laparotomy, earlier for laparoscopy

Haemoglobin Monitoring

• Check CBC on postoperative day 1
• Watch for signs of internal haemorrhage: tachycardia, falling BP, abdominal pain, distension

Vaginal Discharge

• Light haemoserous discharge expected for 4–6 weeks (vault discharge)
• Heavy bleeding, foul smell, or fever → investigate for vault haematoma or infection

Complications to Watch For

Discharge Criteria

• Afebrile, haemodynamically stable
• Tolerating oral intake
• Adequate urine output
• Bowel function returning
• Adequate pain control on oral analgesia

Discharge Instructions

• No intercourse for 6–8 weeks (until vault heals)
• No heavy lifting (>5 kg) for 6 weeks
• Light activity for 2 weeks; full return by 6–8 weeks (abdominal) or 3–4 weeks (laparoscopic/vaginal)
• Follow-up at 6 weeks for vault check
• Hormonal consequences: if bilateral oophorectomy performed → discuss HRT if pre-menopausal

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