Hysterectomy is a surgery to remove the uterus and cervix. “Abdominal” is the surgical technique that will be used. This means the surgery will be done through an incision in your abdomen. A bilateral salpingo-oophorectomy is surgery to remove both of your ovaries and fallopian tubes. The hysterectomy and bilateral salpingo-oophorectomy will both be done during one procedure. This surgery will remove the uterus, cervix, ovaries, and fallopian tubes. After a hysterectomy you will no longer have periods or be able to become pregnant. Why am I having this surgery? There are multiple reasons why your provider may suggest a hysterectomy and salpingectomy: Heavy periods Endometriosis Uterine fibroids Cancer You may also need to have a bilateral salpingo-oophorectomy if you are high risk for ovarian cancer, have certain types of breast cancer, or have ovarian masses or cysts. What happens during this surgery? Before the procedure, you will be given general anesthesia to sleep. Depending on your reason for surgery, the incision may be made either vertically or horizontally. A horizontal incision is made in your lower abdomen along the pubic hair, or bikini, line. A vertical incision is made above or below your belly button down to right above the pubic bone. The surgeon will remove your uterus, cervix, ovaries, and/or fallopian tubes from this incision. What are the risks? This procedure has a small risk of: Bleeding during surgery, which may require a blood transfusion Infection of the bladder or surgical site Damage to surrounding organs (bladder, bowel, and ureters) Possible need for further surgery What should I do to prepare for the procedure? Do not eat or drink anything after midnight the night before your surgery. You will be under anesthesia for the procedure so you will need someone to drive you to and from your appointment. Be sure to arrive two hours before your estimated surgery start time. Ask your provider any questions you may have before the procedure, especially instructions on stopping or continuing to take any existing medications. Follow the instructions from our office to schedule your pre and post op appointments. What should I expect during recovery? After surgery, you will usually need to remain in the hospital for about 2 nights. You should expect a full recovery after surgery to take about 6 weeks. It is normal to have vaginal bleeding and discharge for 1 to 2 weeks after surgery. The discharge and bleeding should gradually decrease. For 6 weeks after surgery, you need to avoid strenuous exercise, lifting heavy objects, and sexual activity. Call your provider if you experience: Fever greater than 100.4 degrees Fahrenheit Severe nausea / vomiting or abdominal pain Heavy bleeding (more than 2 pads soaked per hour) Redness, swelling, or discharge from your incisions

2. F E TA L L I E , P R E S E N TAT I O N ,
AT T I T U D E A N D P O S I T I O N
M U K E S H S A H
P G I
G O O D S A M M E D I C A L C E N T E R
REFERENCE: OBSTETRICWILLIAM 24TH EDITION

3. I. FETAL LIE1. LONGITUDINAL /TRANSVERSE LIE
>The relation of the long axis of the fetus to that of the mother
> present in over 99% of labors at term
PREDISPOSING FACTORS:
1.MULTIPARITY
2. PLACENTA PREVIA
3. HYDRAMNIOS
4. UTERINE ANOMALIES
2. OBLIQUE LIE
>fetal and maternal axis may cross at 45- degree angle
> UNSTABLE LIE, becomes longitudinal or transverse during the course of the labor

4. II.FETAL PRESENTATION AND PRESENTING PART
A. PRESENTING PART
>portion of the body of the fetus that is either foremost within the birth canal or in closest proximity
to it
>portion of the fetus felt through the cervix during vaginal examination
> determines presentation

5. II.FETAL PRESENTATION AND
PRESENTING PART
A.PRESENTING PART
1. LONGITUDINAL LIE- either fetal head or the breech(
creating cephalic or breech presentation)
2.TRANSVERSE LIE-shoulder

6. CEPHALIC PRESENTATION
CLASSIFICATION:
A.VERTEX/ OCCIPUT PRESENTATION
- MORE COMMON
-occipital fontanel is the presenting part
* vertex- lies in front of the occipital fontanel
*occiput- behind the fontanelle
B. SINCIPPUT PRESENTATION
- fetal head partially flexed with the anterior ( large )
fontanel, or bregma

7. CEPHALIC PRESENTATION
CLASSIFICATION:
C. BROW PRESENTATION
- fetal head partially extend with the brow presenting
D. .FACE PRESENTATION
- LESS COMMON
- fetal necksharply extended so that the occiput and
back come in contact and the face in foremost of the birth canal

8. CEPHALIC PRESENTATION
C. BROW
PRESENTATION
D. .FACE
PRESENTATION
A.VERTEX/ OCCIPUT
PRESENTATION
B. SINCIPPUT
PRESENTATION

9. BREECH PRESENTATION
- When the fetus present as breech ,the 3 general configuration are
frank, complete and footling presentation.
PREDISPOSING FACTORS COMPLICATIONS
1. Gestational age ( before term)
2. Hydramnios(>2,000ml)
3. Uterine contractions, associated with great parity
4. Multiple fetuses
5. Hydrocephaly
6. Anencephaly
7. Previous breech delivery
8. Uterine anomalies
9. Pelvic tumors
10. Placenta previa
1. Perinatal morbidity and mortality
2. Low birth weight from pre term delivery, growth restriction or
both
3. Prolapsed cord
4. Placenta previa
5. Fetal, Neonatal, Infant anomalies
6. Uterine anomalies and tumors

10. BREECH PRESENTATION
TYPES:
1.FRANK BREECH
- thigh flexed and the leg extended over the anterior surface
of the body
2. COMPLETE BREECH
- thigh flexed on the abdomen and the legs upon the thigh
3.INCOMPLETE / FOOTLING BREECH
- one or both feet or one of both knees may be lowermost

11. BREECH PRESENTATION
1.FRANK BREECH 2. COMPLETE BREECH 3.INCOMPLETE / FOOTLING BREECH

12. FETAL ATTITUDE OR
POSTURE
ATTITUDE OR HABITUS
-fetus assumes a characteristic posture
-As a rule the fetus forms an ovoid mass that correspond roughly to the shape of the uterine
cavity.
-The fetus become folded or bent upon itself in such a manner that the cack becomes markedly
convex
-The head is sharply flexed so that the chin is almost in contact with the chest

13. FETAL POSITION
• FETAL POSITION
- relationship of the fetal presenting part to the right or left side of the maternal birth
canal
2 POSITION - 1. RIGHT
2. LEFT
- because the presenting part may be either left or right position, there are left and
right occipital , left and right mental, left and right sacral presentation.
DETERMINING POINTS IN VERTEX, FACE AND BREECH PRESENTATION
1. FETAL OCCIPUT
2. CHIN( MENTUM)
3.SACRUM

14. VARIETIES OF PRESENTATION
AND POSITION
-relation of a given portion of the presenting part to the anterior ,
transverse , or posterior portion of the mother pelvis is considered
- 2 positions,3 varieties for each position ( either left or right)
- 6 varieties for each presentation ( three right and three left)

15. OCCIPUT PRESENTATION , POSITION AND VARIETY MAY
BE ABBREVIATED IN CLOCKWISE FASHION AS;
A- ANTERIOR
T-TRANSVERSE
P-POSTERIOR

16. FETAL ATTITUDE OR
POSTURE
LEFT MENTOANTERIOR RIGHT MENTOANTERIOR RIGHT MENTO POSTERIOR

17. FETAL ATTITUDE OR
POSTURE
LONGITUDINAL LIEVERTEX PRESENTATION
LEFT OCCIPUTANTERIOR LEFT OCCIPUT POSTERIOR

18. FETAL ATTITUDE OR
POSTURE
RIGHT OCCIPUTANTERIOR
LONGITUDINAL LIE IN BREECH PRESENTATION
LEFT SACRUM POSTERIOR POSITON (LSP)

19. FETAL ATTITUDE OR
POSTURE
Transverse lie. Right acromiodorsoposterior position (RADP).The shoulder of the
fetus is to the mothers right and back posterior

20. PRESENTATION AND POSITIONS FREQUENCY
PRESENTATION: at near term
1.VERTEX- 96 %
-2/3 LEFT OCCIPUT and 1/3 RIGHT OCCIPUT
2.BREECH – 3.5%
-much greater in earlier pregnancy
* Ultrasonography- 14% ( 29-32 weeks)
-converted spontaneously to vertex as term aproach
3.FACE – 0.3%
4.SHOULDER 0.4 %

21. REASON FOR PREDOMINANCE OF CEPHALIC PRESENTATION
• WHY FETUS ATTERM USUALLY PRESENTS BY VERTEX?
-most logical explanation is that the uterus is piriforn shaped.
* at 32 week-amniotic cavity is large compared to fetal mass and there is
no crowding of the fetus by the uterine walls
- the ratio of the amniotic fluid volume and fetal mass altered bec
amniotic fluid decreases by increasing fetal size.

22. DIAGNOSIS OF PRESENTATION AND POSITION OF THE FETUS
• METHODS TO DETERMIBED FETAL PRESENTATION AND POSITION
1.ABDOMINAL PALPATION- LEOPOLDS MANEUVER
2.VAGINAL EXAMINATION
3. COMBINED EXAMINATION
4.AUSCULTATION
5. ULTRASOUND
6. CT-SCAN DOUBTFUL CASES
7.MRI

23. METHODS TO DETERMINED FETAL PRESENTATION AND POSITION
1. ABDOMINALPALPATION- LEOPOLDS MANEUVER
A.FIRST MANEUVER- the examiner palpate the fundus with the tip of the fingers of
both hand in order to define which fetal pole presents the fundus
BREECH- large, nodular body, head feels hard and round and more freely
movable and ballotable.
B. SECOND MANEUVER- the palm of the examiner hand are placed on either side
of the abdomen , and gentle but deep pressure is exerted.On one side , a hard resistand
structure is felt , the back and on the other , numerous small, irregular and mobile parts
are felt, the fetal extremities.

24. METHODS TO DETERMINED FETAL PRESENTATION AND POSITION
C.THIRD MANEUVER
- employing the thumb and the fingers 0f one hand, the examiner
grasp the lower portion of the maternal abdomen, just above the symphysis
pubis . If the presenting part is not engaged,a movable body will be felt,
usually the fetal head.
D. FOURTH MANEUVER- the examiner faces the mother’s feet and
with the tips of the frst three fingers of each hand, exert deep pressure in
the direction of the axis of the pelvic inlet. If the head presents,one hand is
arrested sooner than the other by a rounded body.

25. Thank You!