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
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period.
This book provides a practical approach to a broad range of procedures in obstetrics and gynaecology. As doctors practicing obstetrics and gynaecology, we care for women on a daily basis who are dependant on our level of practical competence. Our ability to perform a broad range of procedures enables us to in the very least improve the quality of life in women and often save the lives of mothers and babies. Authors have been selected by virtue of their experience with the procedure and the reader is therefore allowed to glean from their experience. This book is aimed at any physician requiring a practical approach to performing procedures in obstetrics and gynaecology. Houseman, interns, residents, registrars and junior specialists will find it very useful.
Author: Stephen Jeffrey
Institution: University of Cape Town
This resource is part of the African Health Open Educational Resources Network: http://www.oerafrica.org/healthoer. The original resource is also available from the authoring institution at http://opencontent.uct.ac.za/.
Creative Commons license: Attribution-Noncommercial-Share Alike 3.0
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period.
This book provides a practical approach to a broad range of procedures in obstetrics and gynaecology. As doctors practicing obstetrics and gynaecology, we care for women on a daily basis who are dependant on our level of practical competence. Our ability to perform a broad range of procedures enables us to in the very least improve the quality of life in women and often save the lives of mothers and babies. Authors have been selected by virtue of their experience with the procedure and the reader is therefore allowed to glean from their experience. This book is aimed at any physician requiring a practical approach to performing procedures in obstetrics and gynaecology. Houseman, interns, residents, registrars and junior specialists will find it very useful.
Author: Stephen Jeffrey
Institution: University of Cape Town
This resource is part of the African Health Open Educational Resources Network: http://www.oerafrica.org/healthoer. The original resource is also available from the authoring institution at http://opencontent.uct.ac.za/.
Creative Commons license: Attribution-Noncommercial-Share Alike 3.0
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
Overview
While it takes nine months to grow a full-term baby, labor and delivery occurs in a matter of days or even hours. However, it’s the process of labor and delivery that tends to occupy the minds of expectant parents the most.
Read on if you have questions and concerns around the signs and length of labor, and how to manage pain.
Signs of labor
Labor has started or is coming soon if you experience symptoms such as:
increased pressure in the uterus
a change of energy levels
a bloody mucus discharge
Real labor has most likely arrived when contractions become regular and are painful.
Braxton Hicks contractions
Many women experience irregular contractions sometime after 20 weeks of pregnancy. Known as Braxton Hicks contractions, they’re typically painless. At most, they’re uncomfortable and are irregular.
Braxton Hicks contractions can sometimes be triggered by an increase in either mother or baby’s activity, or a full bladder. No one fully understands the role Braxton Hicks contractions play in pregnancy.
They may promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Braxton Hicks contractions don’t cause the cervix to dilate. Painful or regular contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of contractions that should lead you to call your doctor.
Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
blockage or problem in the urinary tract can mean urine is unable to drain from the kidneys or is able to flow the wrong way up into the kidneys. This can lead to a build-up of urine in the kidneys, causing them to become stretched and swollen.
An injury higher on the spinal cord can cause paralysis in most of your body and affect all limbs (tetraplegia or quadriplegia). A lower injury to the spinal cord may cause paralysis affecting your legs and lower body (paraplegia)
Scoliosis is the abnormal twisting and curvature of the spine. It is usually first noticed by a change in appearance of the back. Typical signs include: a visibly curved spine. one shoulder being higher than the other.
Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.
With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.
About 4 out of 5 cases of acute pancreatitis improve quickly and don't cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure. In severe cases where complications develop, there's a high risk of the condition being fatal.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
F E T A L L I E , P R E S E N T A T I O N , A T T I T U D E A N D P O S I T I O N
1.
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
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
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
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.