A.the causes could be excess blood loss inta operative that cause hypovolaemia and renal hypoperfusion 2nd urinary tract injury in big or multiple fibroid
B. I will assess woman general condition first pulse b.p. O2 saturation and theen review the note legnth of surgery any difficulty arise asit raise posibility of U.T. injury location of fibroid No. and size of fibroid also monitoring of the pt along surgery as may be wrong estimation of BL. loss
C. The drop in hb cnfirm that the cause related to blood loss so iwill start monitoring of pt hand in hand with resustation as mandated by her general condition and labortry finding best cared in HDU. with MDT. including anaesthesia consultant gynaecologist iwill notify haematotogist and blood bank .according to finding decision of re-laparotomy should be at seniors level and if pt. condition allow shoud be explaind to her otherwise surgeon will act inthe best interest of the pt post op. should becared in HDU. with monitoring of input output chart incident report form shoud be filled regarding re-laparotomy and pt debriefed
