The document discusses the procedure of episiotomy in labor, detailing indications such as preterm labor and breech presentation while highlighting various techniques like median and mediolateral episiotomy. It also covers the concept of fetal version, including external and internal methods, along with their indications, contraindications, timing, and complications. Finally, it touches on historical surgical methods related to obstetrics.

1. By
Magdy Abdelrahman Mohamed
2017

3.  It is an incision of the perineum during
labour.

4.  It is a pyramidal shaped area between
the lower vagina and the anal canal and
the lower end of the rectum.

7.  Avoid irregular tears.
 Avoid fetal intracranial hemorrhage.

8. Absolute:
 Preterm labour.
 Breech presentation.
 During forceps application.

9. Relative:
 Primipara.
 Scarred perineum
 Rigid perineum.
 Narrow subpubic angle.
 Shoulder dystocia.
 Malposition.

10.  Median ( midline) episiotomy:
 Mediolateral episiotomy:
 J shaped episiotomy:

11. Timing.
Local anesthesia.
Repair.

14.  Hematoma.
 Abscess formation.
 Infection and gapped wound.

16.  It is replacement the presenting part by another
one.
 If the aim is to make the head the presenting part
it is called cephalic version and if the breech will
be the presenting part it is podalic version.

17.  External cephalic version.
 Internal podalic version.

18. Indications
* Breech presentation.
* Transverse or oblique lie.

19. Timing:
 Preferred after 36w till onset of labour.

20. Prerequisites :
1. Facilities for monitoring.
 US: FHR visualisation
 CTG: before & after procedure
2. Facilities for immediate delivery .
3. Anti-D immunoglobulin to rhesus-
negative.
4. Informed consent.

21. Contraindications:
 CS is indicated.
 Antepartum haemorrhage within the last 7
days.
 Abnormal CTG.
 Major uterine anomaly.
 Ruptured membranes.
 Multiple pregnancy.

22. Technique:
 No anaesthesia as the pain is a safe guard against
rough manipulations.
 The patient evacuates her bladder.
 She lies in a Trendelenburg position with exposed
vulva to detect any vaginal bleeding.
 The fetal position is determined and FHS is
auscultated.

23. Technique:
 One hand is applied externally to the fetal
head and the other on its buttock.
 The two poles are approximated to flex the
fetus and rotation is done by the two hands
simultaneously to bring the head lower
down.

25.  If neither vaginal bleeding nor fetal distress
results, an abdominal binder is applied to fix the
new position and re-examined twice weekly.
 If the original presentation returned again, the
procedure of version can be repeated.
 Some doctors prefer to induce labour immediately
after successful version.

26. Complications:
 Placental separation.
 Rupture of membrane.
 Fetal distress.

27. Indications:
 Retained second twin in a transverse lie.

28. Pre-requisites:
 General anaesthesia.
 Evacuation of the bladder.
 Complete aseptic conditions.
 Cervix is fully dilated.
 No previous uterine scar.
 Adequate amniotic fluid.

30. Complications:
 Neurogenic shock
 Rupture uterus.
 Puerperal sepsis.

31. HISTORICAL

32.  Craniotomy.
 Decapitation.
 Evisceration.
 Cleidotomy: division one or both calvicle