Pre-op GYN Surgery
- Procedure type: total hysterectomy (TAH/TLH), myomectomy, ovarian cystectomy, D&C, laparoscopy
- Indication: fibroid (menorrhagia, bulk symptoms), endometriosis, ovarian cyst (dermoid, endometrioma), malignancy
- Malignancy prep: oncology consult; CT staging; CA-125, CEA if ovarian; bowel prep ถ้า bowel involvement
- Expected blood loss: hysterectomy 200-500 mL; myomectomy (fibroid size-dependent); crossmatch ถ้า Hb <10 + major surgery
- VTE risk: GYN surgery (especially pelvic) has moderate-high VTE risk — LMWH mandatory
🕐 One-Day Orders
🔬 Investigation
- CBC, BUN/Cr, electrolytes — surgical baseline
- PT/INR, aPTT, platelet
- Blood group + crossmatch (T&S minor; T&C 2 units major/anemia)
- LFT ถ้า hepatic disease or malignancy
- CXR, ECG ถ้าอายุ >45
- CA-125, CA19-9, CEA ถ้าสงสัย ovarian malignancy (pre-op)
- U/S pelvis — ยืนยัน pathology, uterine size, ovarian morphology
- CT abdomen-pelvis ถ้าสงสัย malignancy — lymph node, ascites, metastasis
💊 Medication
- NPO: solid food 8h, clear liquid 2h pre-op
- Pre-op prophylactic ATB (60 min before):
- Ceftriaxone 2 g IV + Metronidazole 500 mg IV — นำไป OR (as-used, major case)
- Metronidazole 500 mg IV ถ้า contaminated หรือ bowel involved
- Bowel prep ถ้า bowel involvement: Polyethylene glycol (PEG) 2-4L PO evening before
- TED stocking + pneumatic compression pre-op
- Hold OCP/HRT ≈4 weeks pre-op — VTE risk
🔁 Continuous Orders
🔬 Investigation
- CBC day 1 post-op — Hb drop; transfuse ถ้า Hb <8 + symptomatic
- Wound + drain check daily
- Pathology result — follow up; malignancy → oncology referral
💊 Medication
- Multimodal analgesia:
- Paracetamol 1 g IV/PO q6h + Diclofenac/Ketorolac
- Tramadol PRN
- Enoxaparin 40 mg SC OD — VTE prophylaxis เริ่ม 6-12h post-op; 28 วัน ถ้า malignancy หรือ high-risk (ASCO guideline)
- Early oral (ERAS) — clear liquid 4h; soft diet day 1; remove NGT early
- Foley removal 12-24h post-op (ERAS)
- HRT discussion post-hysterectomy ถ้า pre-menopausal (premature menopause) — ทีมแพทย์ OB-GYN แนะนำ