Episotomy for undergraduate
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undergraduate course lectures in obstetrics and gynecology prepared by Dr Manal Behery Professor OB&GYNE Faculty of medicine,Zagazig University
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Laparoscopic sterilization was the first popular minimal access surgical procedure ever performed. Laparoscopic sterilization is very straightforward procedure. Worldwide laparoscopic sterilization is now the most commonly applied method for family planning
Presentaion induction of labour
This document discusses induction of labor, which is defined as artificially stimulating uterine contractions before spontaneous labor begins in order to achieve delivery. The document outlines indications for induction such as pregnancy-induced hypertension and post-maturity. It also lists contraindications and risks to induction. Methods of induction discussed include mechanical methods like membrane sweeping, medical methods using prostaglandins and oxytocin, and surgical methods like artificial rupture of membranes. Criteria for induction and the Bishop score for assessing cervical ripening are also presented.
Episiotomy slideshare by dr alka mukherjee & dr apurva mukherjee ms
Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, it is recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.
Episiotomies—incisions made between the vagina and anus during childbirth—have long been a topic of debate among clinicians, researchers and advocates. Outdated clinical guidelines previously recommended the routine use of episiotomy to avoid natural vaginal tearing. Over the past two decades, a growing body of literature and increased advocacy efforts have led to a general consensus that episiotomy should not be conducted as a standard practice. Nevertheless, in many parts of the world, the majority of women still undergo episiotomy during childbirth.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
EPISIOTOMY AND ITS REPAIR.pptx
This document discusses episiotomy, including its definition, purpose, indications, types, repair process, complications, and post-procedure care. An episiotomy is a surgically planned incision made in the perineum and posterior vaginal wall during the second stage of labor. It is performed to facilitate delivery and minimize perineal tearing. The document outlines the various types of episiotomy incisions and repair techniques used to close the vaginal mucosa, perineal muscles, and skin layers. Post-procedure care instructions are provided to promote proper wound healing and prevent complications.
Post term pregnancy
A post-term pregnancy persists 42 weeks or more from the last menstrual period. It occurs in 5-10% of pregnancies and is more common in first-time mothers. Risks include placental insufficiency, low amniotic fluid levels, and difficult labor due to an oversized baby with a more calcified skull. Diagnosis involves assessing gestational age, ultrasound measurements of fetal size and amniotic fluid levels, and tests of placental function. Management seeks to induce labor if safe for vaginal delivery, or perform a Caesarean section if conditions are not suitable for induction or it fails.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Abnormal uterine contraction
The document discusses various types of abnormal uterine action during labor including inefficient contractions, hyperactive contractions, and abnormal patterns of contraction. Specific conditions like uterine inertia, hypertonic uterus, constriction rings, and cervical dystocia are described along with their causes, clinical features, and management. Overall the document provides an overview of deviations from normal uterine function during labor and delivery.
Pre mature rupture of membrene
1) Premature rupture of membrane (PROM) is defined as the rupture of amniotic sac more than 1 hour before the onset of labor.
2) PROM can be classified as preterm (before 37 weeks gestation), prolonged (rupture of membranes for over 24 hours before onset of labor), or pre-viable (before 24 weeks gestation).
3) Causes and risk factors of PROM include infections, smoking, previous preterm labor or PROM, polyhydramnios, multiple gestation, bleeding during pregnancy, invasive procedures, and cervical insufficiency. Diagnosis involves history collection, examination, and tests to assess fetal wellbeing.
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This document discusses induction of labor, which is defined as artificially stimulating uterine contractions before spontaneous labor begins in order to achieve delivery. The document outlines indications for induction such as pregnancy-induced hypertension and post-maturity. It also lists contraindications and risks to induction. Methods of induction discussed include mechanical methods like membrane sweeping, medical methods using prostaglandins and oxytocin, and surgical methods like artificial rupture of membranes. Criteria for induction and the Bishop score for assessing cervical ripening are also presented.
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Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, it is recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.
Episiotomies—incisions made between the vagina and anus during childbirth—have long been a topic of debate among clinicians, researchers and advocates. Outdated clinical guidelines previously recommended the routine use of episiotomy to avoid natural vaginal tearing. Over the past two decades, a growing body of literature and increased advocacy efforts have led to a general consensus that episiotomy should not be conducted as a standard practice. Nevertheless, in many parts of the world, the majority of women still undergo episiotomy during childbirth.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
EPISIOTOMY AND ITS REPAIR.pptx
This document discusses episiotomy, including its definition, purpose, indications, types, repair process, complications, and post-procedure care. An episiotomy is a surgically planned incision made in the perineum and posterior vaginal wall during the second stage of labor. It is performed to facilitate delivery and minimize perineal tearing. The document outlines the various types of episiotomy incisions and repair techniques used to close the vaginal mucosa, perineal muscles, and skin layers. Post-procedure care instructions are provided to promote proper wound healing and prevent complications.
Post term pregnancy
A post-term pregnancy persists 42 weeks or more from the last menstrual period. It occurs in 5-10% of pregnancies and is more common in first-time mothers. Risks include placental insufficiency, low amniotic fluid levels, and difficult labor due to an oversized baby with a more calcified skull. Diagnosis involves assessing gestational age, ultrasound measurements of fetal size and amniotic fluid levels, and tests of placental function. Management seeks to induce labor if safe for vaginal delivery, or perform a Caesarean section if conditions are not suitable for induction or it fails.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Abnormal uterine contraction
The document discusses various types of abnormal uterine action during labor including inefficient contractions, hyperactive contractions, and abnormal patterns of contraction. Specific conditions like uterine inertia, hypertonic uterus, constriction rings, and cervical dystocia are described along with their causes, clinical features, and management. Overall the document provides an overview of deviations from normal uterine function during labor and delivery.
Pre mature rupture of membrene
1) Premature rupture of membrane (PROM) is defined as the rupture of amniotic sac more than 1 hour before the onset of labor.
2) PROM can be classified as preterm (before 37 weeks gestation), prolonged (rupture of membranes for over 24 hours before onset of labor), or pre-viable (before 24 weeks gestation).
3) Causes and risk factors of PROM include infections, smoking, previous preterm labor or PROM, polyhydramnios, multiple gestation, bleeding during pregnancy, invasive procedures, and cervical insufficiency. Diagnosis involves history collection, examination, and tests to assess fetal wellbeing.
Induction of labour
This document defines induction of labor as artificially initiating uterine contractions before spontaneous labor begins. It lists several medical indications for induction, such as post-term pregnancy, preeclampsia, IUGR, and others. It also discusses contraindications and complications of induction. Several methods of induction are described, including pharmacological methods using prostaglandins and oxytocin, as well as non-pharmacological methods like membrane stripping, amniotomy, and balloon catheters. Factors that increase the success of induction like bishop score and gestational age are also summarized.
Induction of labour
Induction of labour involves initiating uterine contractions before spontaneous labour begins. It can be done for various maternal or fetal indications when the risks of continuing pregnancy outweigh those of early delivery. Successful induction depends on factors like gestational age, cervical status assessed by Bishop score, and sensitivity to oxytocin. Cervical ripening methods include prostaglandins, misoprostol, oxytocin, mifepristone and mechanical methods. Once the cervix is ripe, oxytocin infusion is used to induce contractions. Artificial rupture of membranes is another surgical method to induce labour. Careful patient selection and monitoring are important for safe induction of labour.
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Placenta Previa is one type of Antepartum Hemorrhage and an obstetrical emergency too... So in health care management having knowledge regarding this topic is very important in Obstetrics.
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This document discusses multiple pregnancy (twins, triplets etc.). It begins by defining multiple pregnancy as the simultaneous development of more than one fetus in the uterus. The most common type is twins (two fetuses), although three, four, five or six fetuses may also occasionally develop. It notes that twins resulting from two separate eggs (dizygotic) are more common than those from a single egg splitting (monozygotic). Risk factors, diagnostic evaluations, complications and management of multiple pregnancies are discussed in detail.
Management of first stage labour
The document describes the stages and phases of labor and delivery. It discusses:
1. The first stage consists of 3 phases - the latent phase (0-3cm dilation), active phase (4-7cm dilation), and transitional phase (7-10cm dilation). Contraction frequency and intensity increase through each phase.
2. Key aspects of nursing care in the first stage include monitoring maternal and fetal wellbeing, ensuring comfort and support, and teaching breathing and pushing techniques.
3. A partogram (partograph) is used to graphically monitor labor progress, contractions, and fetal conditions on one page to easily identify normal vs abnormal progress. It allows early recognition of issues like slow dilation.
Vaginal examination
The document describes the procedure for examining the vagina using a speculum. It involves inserting a plastic or metal speculum to assess the vulva, vagina, and cervix. It lists the equipment needed, including different sizes of vaginal speculums, KY jelly, gloves, and a torch light. It provides steps for positioning the patient, inserting the speculum, examining the vaginal area, and post-procedure care instructions.
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This document discusses induction of labour, which is defined as artificially stimulating uterine contractions before the onset of natural labour. It outlines the goals, indications, methods, and nursing responsibilities for labour induction. The main methods discussed are medical induction using prostaglandins or oxytocin, and surgical induction through membrane stripping or artificial rupture of membranes. The nursing responsibilities involve properly administering induction medications and procedures, monitoring the woman and fetus during labour induction, and providing general care and support to the woman and newborn.
Shoulder dystocia
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
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Cervical incompetence
This document discusses cervical incompetence, also known as cervical insufficiency. It defines cervical incompetence as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor during the second trimester. The document outlines the causes, diagnosis, and management of cervical incompetence, with a focus on cervical cerclage procedures like the McDonald and Shirodkar techniques. Cervical cerclage involves surgically placing a suture around the cervix to reinforce it and prevent painless dilation during pregnancy.
Disorder of uterine contraction & precipitate labour.pptx
This document discusses abnormal uterine contractions during labor and delivery. It defines different types of abnormalities including excessive contractions, uterine inertia, abnormal polarity, spastic lower segment, colicky uterus, asymmetric contractions, constriction rings, and generalized tonic contractions. It provides causes, clinical presentations, diagnoses and management for each abnormality. Risks of prolonged labor like fetal distress and maternal exhaustion are also summarized.
Breech Presentation
Management of cases with Vaginal Breech Delivery.
Dr Manavita Mahajan is a renowned Gynaecologist and is a Sr. Consultant at FRMI, Gurgaon. You can contact her at www.drmanavitamahajan.in
ABNORMAL LABOUR
Definitions
Stages and Phases of Normal Labour
Abnormal Patterns of Labour
Classification of Abnormal Labour/Dystocia
Diagnosis and Management of Abnormal Labour
Caesarean section
Caesarean section is a surgical procedure to deliver a baby through abdominal and uterine incisions after 28 weeks of pregnancy. The incidence of C-sections has increased due to abandoning difficult procedures and increased use for breech births. Indications include maternal conditions like pelvic abnormalities and previous C-sections, as well as fetal indications like distress. A lower segment transverse incision is most common. Complications can include hemorrhage, injury, infection and rupture of the uterine scar in subsequent pregnancies.
Malpresentations&malpositions
This document discusses abnormal fetal positions and presentations during labor and delivery. It defines malpositions as longitudinal lie with the fetus not in occiput anterior position (such as occiput posterior or transverse) and malpresentations as anything other than vertex (such as breech, face, brow, shoulder, or compound). Management may include external cephalic version, vaginal delivery with maneuvers, or caesarean section depending on the specific presentation and other factors.
Uterine Inversion 2018
Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It can range from the fundus inverting into the cervix to the entire uterus prolapsing outside the body. Prompt diagnosis and management is needed to prevent shock. The uterus must be manually or surgically replaced before detaching the placenta to avoid hemorrhage. Prevention involves controlled cord traction and avoiding fundal pressure until the placenta separates naturally.
Caesarean section
1. Caesarean section is a surgical procedure where the fetus, placenta, and membranes are delivered through an incision in the abdominal wall and uterus.
2. The incidence of caesarean sections has steadily increased over the last decade from around 10% to 30% due to improved safety, identification of risk factors, and increased awareness of fetal well-being.
3. Indications for caesarean include cephalopelvic disproportion, previous uterine scar, fetal distress, and malpresentations; contraindications include a dead fetus or one that is too premature.
Induction of labour (2)
This document discusses induction and augmentation of labor. It begins by defining induction of labor as artificially stimulating uterine contractions before the onset of labor, while augmentation refers to stimulating inadequate spontaneous contractions. The document then covers the structures and physiology of the cervix as it relates to ripening. It discusses various methods of assessing cervical status including Bishop's score and indications, contraindications, risks and prerequisites for labor induction. The document provides an overview of common methods used for cervical ripening and labor induction.
Perineal lacerations
The document describes the anatomy of the pelvic floor, urogenital diaphragm, and perineum. It discusses the levator ani muscles that form the pelvic floor and their functions in supporting pelvic organs and assisting in childbirth. It describes the urogenital diaphragm deep to the pelvic floor and the perineal spaces and triangles below. The document then discusses perineal tears that can occur during childbirth, their degrees of severity, symptoms, repair techniques, and complications if left untreated.
Uterine rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Episiotomy
A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour is called episiotomy.
Presentation episiotomy
This document discusses episiotomy, including its definition as a surgically planned incision made during childbirth, purposes such as facilitating delivery and reducing perineal tearing, types (median, mediolateral, lateral), indications, advantages, repair process, post-operative care, and potential complications. The repair process involves suturing the vaginal mucosa, perineal muscles, and skin in layers to restore anatomical structure while controlling bleeding and preventing infection.
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Induction of labour
This document defines induction of labor as artificially initiating uterine contractions before spontaneous labor begins. It lists several medical indications for induction, such as post-term pregnancy, preeclampsia, IUGR, and others. It also discusses contraindications and complications of induction. Several methods of induction are described, including pharmacological methods using prostaglandins and oxytocin, as well as non-pharmacological methods like membrane stripping, amniotomy, and balloon catheters. Factors that increase the success of induction like bishop score and gestational age are also summarized.
Induction of labour
Induction of labour involves initiating uterine contractions before spontaneous labour begins. It can be done for various maternal or fetal indications when the risks of continuing pregnancy outweigh those of early delivery. Successful induction depends on factors like gestational age, cervical status assessed by Bishop score, and sensitivity to oxytocin. Cervical ripening methods include prostaglandins, misoprostol, oxytocin, mifepristone and mechanical methods. Once the cervix is ripe, oxytocin infusion is used to induce contractions. Artificial rupture of membranes is another surgical method to induce labour. Careful patient selection and monitoring are important for safe induction of labour.
Placenta previa
Placenta Previa is one type of Antepartum Hemorrhage and an obstetrical emergency too... So in health care management having knowledge regarding this topic is very important in Obstetrics.
Multiple pregnancy 1
This document discusses multiple pregnancy (twins, triplets etc.). It begins by defining multiple pregnancy as the simultaneous development of more than one fetus in the uterus. The most common type is twins (two fetuses), although three, four, five or six fetuses may also occasionally develop. It notes that twins resulting from two separate eggs (dizygotic) are more common than those from a single egg splitting (monozygotic). Risk factors, diagnostic evaluations, complications and management of multiple pregnancies are discussed in detail.
Management of first stage labour
The document describes the stages and phases of labor and delivery. It discusses:
1. The first stage consists of 3 phases - the latent phase (0-3cm dilation), active phase (4-7cm dilation), and transitional phase (7-10cm dilation). Contraction frequency and intensity increase through each phase.
2. Key aspects of nursing care in the first stage include monitoring maternal and fetal wellbeing, ensuring comfort and support, and teaching breathing and pushing techniques.
3. A partogram (partograph) is used to graphically monitor labor progress, contractions, and fetal conditions on one page to easily identify normal vs abnormal progress. It allows early recognition of issues like slow dilation.
Vaginal examination
The document describes the procedure for examining the vagina using a speculum. It involves inserting a plastic or metal speculum to assess the vulva, vagina, and cervix. It lists the equipment needed, including different sizes of vaginal speculums, KY jelly, gloves, and a torch light. It provides steps for positioning the patient, inserting the speculum, examining the vaginal area, and post-procedure care instructions.
Induction of labour ppt
This document discusses induction of labour, which is defined as artificially stimulating uterine contractions before the onset of natural labour. It outlines the goals, indications, methods, and nursing responsibilities for labour induction. The main methods discussed are medical induction using prostaglandins or oxytocin, and surgical induction through membrane stripping or artificial rupture of membranes. The nursing responsibilities involve properly administering induction medications and procedures, monitoring the woman and fetus during labour induction, and providing general care and support to the woman and newborn.
Shoulder dystocia
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
FORCEP DELIVERY.pptx
A forceps delivery is a type of assisted delivery. Instrumental delivery refers to any delivery process which is assisted by vaginal operations. It is an art, which should be learnt by all obstetricians for optimum maternal and perinatal outcome.
Cervical incompetence
This document discusses cervical incompetence, also known as cervical insufficiency. It defines cervical incompetence as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor during the second trimester. The document outlines the causes, diagnosis, and management of cervical incompetence, with a focus on cervical cerclage procedures like the McDonald and Shirodkar techniques. Cervical cerclage involves surgically placing a suture around the cervix to reinforce it and prevent painless dilation during pregnancy.
Disorder of uterine contraction & precipitate labour.pptx
This document discusses abnormal uterine contractions during labor and delivery. It defines different types of abnormalities including excessive contractions, uterine inertia, abnormal polarity, spastic lower segment, colicky uterus, asymmetric contractions, constriction rings, and generalized tonic contractions. It provides causes, clinical presentations, diagnoses and management for each abnormality. Risks of prolonged labor like fetal distress and maternal exhaustion are also summarized.
Breech Presentation
Management of cases with Vaginal Breech Delivery.
Dr Manavita Mahajan is a renowned Gynaecologist and is a Sr. Consultant at FRMI, Gurgaon. You can contact her at www.drmanavitamahajan.in
ABNORMAL LABOUR
Definitions
Stages and Phases of Normal Labour
Abnormal Patterns of Labour
Classification of Abnormal Labour/Dystocia
Diagnosis and Management of Abnormal Labour
Caesarean section
Caesarean section is a surgical procedure to deliver a baby through abdominal and uterine incisions after 28 weeks of pregnancy. The incidence of C-sections has increased due to abandoning difficult procedures and increased use for breech births. Indications include maternal conditions like pelvic abnormalities and previous C-sections, as well as fetal indications like distress. A lower segment transverse incision is most common. Complications can include hemorrhage, injury, infection and rupture of the uterine scar in subsequent pregnancies.
Malpresentations&malpositions
This document discusses abnormal fetal positions and presentations during labor and delivery. It defines malpositions as longitudinal lie with the fetus not in occiput anterior position (such as occiput posterior or transverse) and malpresentations as anything other than vertex (such as breech, face, brow, shoulder, or compound). Management may include external cephalic version, vaginal delivery with maneuvers, or caesarean section depending on the specific presentation and other factors.
Uterine Inversion 2018
Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It can range from the fundus inverting into the cervix to the entire uterus prolapsing outside the body. Prompt diagnosis and management is needed to prevent shock. The uterus must be manually or surgically replaced before detaching the placenta to avoid hemorrhage. Prevention involves controlled cord traction and avoiding fundal pressure until the placenta separates naturally.
Caesarean section
1. Caesarean section is a surgical procedure where the fetus, placenta, and membranes are delivered through an incision in the abdominal wall and uterus.
2. The incidence of caesarean sections has steadily increased over the last decade from around 10% to 30% due to improved safety, identification of risk factors, and increased awareness of fetal well-being.
3. Indications for caesarean include cephalopelvic disproportion, previous uterine scar, fetal distress, and malpresentations; contraindications include a dead fetus or one that is too premature.
Induction of labour (2)
This document discusses induction and augmentation of labor. It begins by defining induction of labor as artificially stimulating uterine contractions before the onset of labor, while augmentation refers to stimulating inadequate spontaneous contractions. The document then covers the structures and physiology of the cervix as it relates to ripening. It discusses various methods of assessing cervical status including Bishop's score and indications, contraindications, risks and prerequisites for labor induction. The document provides an overview of common methods used for cervical ripening and labor induction.
Perineal lacerations
The document describes the anatomy of the pelvic floor, urogenital diaphragm, and perineum. It discusses the levator ani muscles that form the pelvic floor and their functions in supporting pelvic organs and assisting in childbirth. It describes the urogenital diaphragm deep to the pelvic floor and the perineal spaces and triangles below. The document then discusses perineal tears that can occur during childbirth, their degrees of severity, symptoms, repair techniques, and complications if left untreated.
Uterine rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
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An episiotomy is an incision made in the perineum during childbirth to widen the vaginal opening. It can help prevent tearing of the perineum and complications like prolapse or incontinence. Episiotomies are commonly performed for first-time mothers, instrumental deliveries, or large babies. The most common type is a median incision, while a mediolateral cut may be used for more difficult deliveries. The incision is made and then repaired after delivery to help with healing.
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An episiotomy is a surgically planned incision made in the perineum and posterior vaginal wall during the second stage of labor to prevent severe tearing and assist with delivery when needed. There are different types of episiotomies including median, mediolateral, and lateral incisions, with mediolateral being the most commonly performed. Potential complications of episiotomies include rectal involvement, bleeding, infection, wound disruption, pain during sex, and scar issues.
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Episotomy for undergraduate
- 1. DR Manal Behery Professor Ob&Gyne Zagazig University 2014
- 2. DefinitionDefinition Intrapartum incision of perineum also called perinotomy Types Median (midline):midline incision of perineum Mediolateral :begins in midline but directed laterally .
- 3. Types of episotomyTypes of episotomy
- 4. IndicationsIndications – Use for maternal or fetal indications 1-Reduce second stage of labor 2-Avoiding severe maternal lacerations 3-Allow slow controlled dilation and delivery 4-With instrumental delivery to reduce trauma to pelvic floor
- 5. Does every case needs episotomy?Does every case needs episotomy? ACOG Do not support routine or “liberal” use – Gradual decrease in use in 1980
- 6. Rapidly do episiotomy inRapidly do episiotomy in – 1-Non reassuring CTG – 2-Shoulder dystocia – 3-Operative vaginal delivery – 4- Breech Delivery
- 7. Episotomy for shoulderEpisotomy for shoulder dystociadystocia
- 8. Before forceps applicationBefore forceps application
- 9. Delivery of aftercoming headDelivery of aftercoming head in breechin breech
- 10. At what time in labor youAt what time in labor you should do an episotomy ?should do an episotomy ?
- 11. Just at Crowning:Just at Crowning:
- 12. Before Crowning AfterBefore Crowning After 12
- 13. What type of anesthesia???What type of anesthesia???
- 14. Local infiltration anathesiaLocal infiltration anathesia
- 15. Pudendal nerve blockPudendal nerve block . .
- 16. Give plenty of anesthesiaGive plenty of anesthesia Even patients with epidurals can benefit fromEven patients with epidurals can benefit from local injection due to varying levels oflocal injection due to varying levels of anesthesiaanesthesia
- 17. Muscle cutted in episiotomyMuscle cutted in episiotomy
- 19. Vaginal RepairsVaginal Repairs Goal is to return all structures to normal anatomy Use the hymen remnant as key landmark Suture used – 2-0 Vicryl or monocryl common – 2-0 chromic maybe used but some patients can have reactions
- 24. Problems arising from EpisiotomyProblems arising from Episiotomy 24 Pain Edema Bleeding Infection Defects in wound
- 25. Extension TearsExtension Tears Generally •1st and 2nd degree tears are simple to repair •If you haven’t done many 3rd and 4th degree tears call for help Gyn or Colorectal
- 26. Anal sphincter or rectal injuryAnal sphincter or rectal injury
- 28. Extension tear during episotomyExtension tear during episotomy
- 29. Extension tear during episotomyExtension tear during episotomy
- 33. Pain after EpisiotomyPain after Episiotomy Topical lidocaine not effective .1- Ice packs 2. Pressure dressings 3. Appropriate analgesia
- 34. Pain out of proportion can be sign of vulvar,Pain out of proportion can be sign of vulvar, paravaginal, ischiorectal hematoma orparavaginal, ischiorectal hematoma or cellulitiscellulitis – Examine patient if stable non expandinghematoma can monitor
- 35. Need for surgical interventionsNeed for surgical interventionsNeed for surgical interventionsNeed for surgical interventions 1. Haematomas >5cm in diameter1. Haematomas >5cm in diameter 2. Rapidly expanding2. Rapidly expanding Infra-levetor hematoma
Editor's Notes
- Whether its midline or lateral repair is the same
- Crown stictch after bringing hymen remnant to normal anatomic position. Make sure that you just return normal anatomy for the patient. When we do cosmetic vaginoplasty and tightening we do a similar procedure to tighten the vagina back up to a condition prior to childbirth but taking aggressive bites can make the opening too small. Also with re-hymenization procedures key is to return normal anatomy
- Note that the tissues of the pelvis have a lot of room to expand. I have taken out 1300cc’s from a side wall hematoma before. Also note that most of the pregnant patients are young and generally in good health so they can tolerate and compensate for blood loss until they suddenly crash. Also remember that these patients have built up an increase of 50% plasma and 30% blood during the pregnancy so they can loose quite a bit more than a regular trauma patient.