THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
under and post graduate best presentation ever about the assisted vaginal delivery,operative vaginal delivery, or instrumental vaginal delivery.
done by waill salan al.timeemi/stager 2014-2015/ Iraq-al.qadisiyyah college of medicine.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
under and post graduate best presentation ever about the assisted vaginal delivery,operative vaginal delivery, or instrumental vaginal delivery.
done by waill salan al.timeemi/stager 2014-2015/ Iraq-al.qadisiyyah college of medicine.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Obstetrical Surgeries - Operative vaginal deliveries are accomplished by appl...MariaDavis42
Operative vaginal deliveries are accomplished by applying direct traction on the fetal skull with forceps or by applying traction to the fetal scalp by means of a vacuum extractor
Fetal malpositioning & malpresentation can pose a serious threat to maternal & fetal well being. The document discusses the risks, complication, and management of some of the common malpresentation & malpositioning.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
Brief overview of operative vaginal delivery as a method of expediting the second stage of labor. The presentation covers both forceps and vacuum delivery including their indications, applications and complications.
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
RRRR IN OBSTETRIC HEMORRHAGE 09012024 AICOG 2024 HEYDERABAD.pptxNiranjan Chavan
This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth
Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptxNiranjan Chavan
Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. • Obstetrics is not an exact science
Greater the difficulty
, greater the glory !!!
4. Many difficulties attend Caesarean section, and many disasters
can follow it
Difficulty in extraction of the fetus
Torrential bleeding
Disasters with the urinary tract and many other……….
Fortunately, most of the others are rare. Some of these
many difficulties are only seen in the developing
world, where operators find themselves working under
difficult circumstances.
6. Deliver breech first
If instead of leg,
hand comes out
reposit it back and
then search for
buttocks
Legs are recognized
by feeling of the
Heel, ankle is held
like a cigarette butt
between index and
middle finger
You may have to
make an inverted
''T' incision on rare
occasions
Transverse
lie
8. • The dorsosuperior (back up) transverse lie may be
delivered as a footling breech through a low transverse
incision.
• Consequently, a vertical incision in the uterus is usually
employed in these cases.
• If the foetal membranes are intact at the time the caesarean
delivery is performed, intra-abdominal version of the foetus
can convert the transverse lie to a cephalic or breech
presentation allowing delivery through a low-segment
transverse incision.
12. • Extremely low birth weight infants (premature or growth
restricted) present many challenges at caesarean
delivery.
• The lower uterine segment is less well-developed
(thicker myometrium, smaller area).
• Thus, the uterine incision is deeper and bloodier, and an
adequate transverse incision to allow atraumatic
extraction of the foetus may not be possible.
• It is also easy to inadvertently lacerate the foetus,
especially in the setting of premature ruptured
membranes, if the deepest layers if the myometrium are
not incised carefully.
13. • Also, because of the markedly reduced foetal size, the
uterus is significantly smaller and occupies less of the
abdomen and pelvis than larger, term pregnancies.
Thus, the mother's intestines, which are usually confined
to the upper abdomen in a caesarean delivery, frequently
descend into the operative field and need to be manually
displaced with either retractors or packing.
15. • Deeply engaged foetal heads that are difficult to deliver
complicate about 1.5 percent of caesarean deliveries.
• These cases often follow a prolonged second stage and
failed attempts at operative vaginal delivery.
• The impacted head places the infant at increased risk of
intracranial haemorrhage, skull fractures, neck fractures,
and asphyxia injuries, while simultaneously increasing
the risk of maternal complications, such as severe
uterine lacerations, damage to the uterine vessels, and
injury to the lower urinary tract.
16. • The best methods to dislodging the deeply engaged foetal
head include:
• Abdominovaginal delivery:
• An assistant cups the foetal head vaginally in one hand and
elevates to meet the operator’s hand.
• The mother's legs are abducted into the "Whitmore" or
"frog" position on the operating room table.
17. PATWARDHAN’S SHOULDERS FIRST
TECHNIQUE:
• The technique involves first delivering the anterior
shoulder and arm and then rotating the foetus and
delivering the posterior shoulder and arm.
• The foetal trunk, breech, and lower limbs are then
successively delivered through the incision using a
combination of gentle traction on the arms, fingers
beneath the thorax, and fundal pressure.
• Once the body is delivered, the head is lifted out of the
pelvis in the same manner as a reverse breech
extraction.
18.
19. MODIFIED PATWARDHAN’S
TECHNIQUE
• If back of the baby is posterior, anterior
shoulder is first delivered followed by the
corresponding lower limb.
• Then the contralateral lower limb is delivered.
The foetal breech and the truck are then
successively delivered followed by the posterior
shoulder and arm.
21. Patwardhan manoeuvre
Modified Patwardhan manoeuvre
Assistant can push head through vagina before opening
uterus.
Don't lever head out with your whole hand, because this
can cause vertical downward tears in the lower segment
Difficulty in delivering head in
obstructed labour
22. USE OF A HEAD
ELEVATORS
• Foetal head elevators or obstetrical
spoons are available in several
variations, including the Coyne spoon,
the Sellheim spoon and the Murless
head extractor.
• All three instruments essentially
function as obstetrical "shoe horns."
• They take up less space than the
obstetrician's hand, thus they are
easier to get around a tightly impacted
head.
24. REVERSE BREECH EXTRACTION
TECHNIQUE:
• Described by Fong and Arulkumaran in Singapore in
1997.
• The operator's hand is inserted into the uterus towards
the fundus to grasp the foetal feet, which are then pulled
to perform a footling breech extraction.
• When grasping, and pulling the feet, care must be taken
to apply traction only parallel to the axis of the legs to
avoid fracturing the foetal tibia and/or fibula.
25. • Compared with the traditional abdominopelvic delivery
technique, the reverse breech extraction technique has
been reported to reduce uterine lacerations/extension of
the incision, as well as maternal infectious morbidity and
blood loss.
28. • Abdominal delivery no different from vaginal breech
extraction with many of the risks
• Limb manipulated through natural range of movement
Delivery of after coming of head
• Avoid trapping of the after coming of head retracting uterus
especially in premature breech
• Mauriceau Smellie Veit maneuver
• Forcep application
29. • The abdominal and uterine incisions should be
sufficiently large to allow easy, atraumatic fetal
extraction.
• A low transverse hysterotomy incision is adequate in
most term or near-term pregnancies
33. FLOATING HEAD
• Head might not be engaged during caesarean section with
a poorly formed and highly vascular lower uterine segment.
• Foetus should be manipulated in longitudinal lie and
steadied with lateral support.
34. • After amniotomy, the liquor should be allowed to drain
completely as this facilitates the descent of head
especially in cases of polyhydramnios.
• The floating foetal head is difficult for the obstetrician to
grasp or establish traction; it cannot readily be pulled
and guided through the incision.
• Applying fundal pressure is often inadequate and tends
to push the head laterally rather than towards the
hysterotomy.
35. • Delivery of floating, non-engaged head can be facilitated
by:
Vectis / Forceps extraction or Vaccum :
• In some cases, single blade of the forceps can be used
as a Vectis for baby delivery.
• Previously Barton’s forceps, which had a hinged anterior
blade and sliding lock, was used.
• Preference is to place an obstetrical vacuum extractor
over the flexion point to deliver the foetal head.
36. • Video of VECTIS Application for extraction of Fetal Head.
38. • Conjoined twins are identical twins whose bodies are
joined in utero.
• It’s a rare phenomenon with an incidence of 1 in 50,000-
100,000 births.
• The incidence is somewhat higher incidence in Africa
and Southwest Asia.
• Females are affected more often than males.
41. • Management of conjoined twins begins when the
diagnosis is made.
• Elective termination is often advised when there is a
cardiac or cerebral fusion, as separation is rarely
successful, and is often considered if severe deformities
are anticipated after separation.
• If the pregnancy is continued, elective Clasical cesarean
section or Inverted T shape incision on Lower uterine
segment extending to upper uterine segment.
43. Reduction of tension
Wide U-shaped transverse incision
with the point of the '‘U' lying
across the middle of the scar
HEAD IS STUCK TIGHTLY
UNDER AN OLD SCAR IN
HER UTERUS,
If her uterus does tear, it will do
so near the midline, where you can
more easily see and repair it
44. If Uterine incision tears
while removing head
Vertical tear
running behind
bladder with
heavy bleeding
Mobilize bladder
further
downwards
If tear not seen
clearly Open
broad and round
ligament to avoid
injury to ureter
Direct pressure
on bleeding edges
and vessels
Interrupted
sutures in the
area of tear
IF BLEEDING NOT CONTROLLED THEN TO DO
SYSTEMATIC DEVASCULARISATION PROCEDURE
46. “ATRAUMATIC DELIVERY IS THE GOAL
OF AN OBSTETRICIAN”
Possible causes of injury
• Haste or difficult delivery
• Inappropriate or inadequate uterine incision trapping the fetal
parts
• Deep or uncontrolled uterine incision lacerating the fetal parts
47. SUMMARY
• BE SAFE
• BE SURE OF WHAT YOUR DOING
• BE SWIFT IN YOUR SURGERY
• BE SOUND IN YOUR CLINICAL AND SURGICAL SKILLS
• DO SURGERY RELENTLESSLY & BLOODLESS
• OBSTETRICIANS SHOULD HAVE LADIES FINGERS
• LIONS HEART
• EAGLES EYES
• & GOOD HAND DEXTERITY