Forceps delivery and vacuum extraction are operative vaginal deliveries that can be used when a vaginal delivery is not progressing normally. Forceps are metal instruments with curved blades that grasp the fetal head, while vacuum extraction uses suction from a cup placed on the fetal scalp to assist delivery. Both have specific prerequisites, techniques, and risks that require an experienced provider to minimize risks to the mother and baby. Complications can include fetal scalp injuries, so careful application and monitoring are important.
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.
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
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.
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
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
A review of clinical pelvimetry and its usefulness in determining if a operative vaginally delivery may be performed. Multiple types of forceps are reviewed. This is a must read for all obstetric providers.
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.
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
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.
- 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
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
A review of clinical pelvimetry and its usefulness in determining if a operative vaginally delivery may be performed. Multiple types of forceps are reviewed. This is a must read for all obstetric providers.
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.
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
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.
- 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
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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.
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.
2. INTRODUCTION
• Forceps delivery is an operative delivery
conducted with the help of obstetric forceps
• Obstetrics forceps is a pair of instruments
specially designed to assist extraction of fetal
head and thereby accomplishing delivery of
the fetus.
3. HISTORY OF FORCEPS
• The credit for design and early use of
forceps goes to Chamberlen of England.
• The credit for using pelvic curve – Levert
(1747)
• Smellie gave us the English lock
• Tarnier -axis traction device.
4. ANATOMY OF FORCEPS
FORCEPS- These instruments consist of two crossing
branches. Its components are-
BLADE- fenestrated for good grip of fetal head
SHANK
LOCK
HANDLE
CEPHALIC CURVE- conforms to shape of fetal head.
PELVIC CURVE-corresponds to axis of birth canal.
.
5. ANATOMY OF FORCEPS contd..
• A sliding lock is used in Kielland forceps.
• Total length of long obstetric forceps is
37cm.
• The distance between two tips - 2.5cm
(when locked).
• The widest diameter between blade is
9cm.
8. VARIETIES OF OBSTETRIC FORCEPS
• CONVENTIONAL TRACTION
FORCEPS
• SHORT FORCEPS-
Wrigleys, Short Simpson
• LONG FORCEPS-Das
Simpson
• LONG FORCEPS with
AXIS TRACTION-
Milne Murray,
Haig Fergusen,
Nevelles Barnes
9. ROTATION FORCEPS.
FORCEPS FOR SPECIAL
USE.
• Kielland, Moolgaokar,
Barton(for transverse
arrest in flat pelvis)
• AFTER COMING HEAD
OF BREECH-Pipers.
• AT CAESARIAN SECTION-
Hale
12. • The current classification of ACOG(2000,
2002) emphasizes the two most important
discriminators of risk for both mother and
infant are station and rotation.
• Station is measured in cm -5 to 0 to +5.
Deliveries are categorized as outlet, low, and
mid-pelvic procedures.
• High forceps in which instruments are applied
above 0 station have no place in
contemporary obstetrics.
13. CLASSIFICATION OF FORCEPS DELIVERY-
ACCORDING TO STATION AND ROTATION
OUTLET FORCEPS-
-Scalp is visible at the introitus without
separating the labia.
-Fetal scalp has reached pelvic floor.
-Saggital suture is in antero-posterior diameter
or right or left occiput anterior or posterior
position
-Fetal head is at or on perineum.
-Rotation does not exceed 45 degrees.
14. LOW FORCEPS
• Leading point of fetal skull is at station greater
or equal to +2cm and not on pelvic floor and
• Rotation is 45 degrees or less.
• Rotation is greater than 45 degrees.
MIDFORCEPS- Station is between 0 and till 2cm.
HIGH FORCEPS- Not included in classification
15. FUNCTIONS OF FORCEPS
• The most important function of forceps is
traction but can be used for rotation for
occiput transverse and posterior positions.
• To provide a protective cage for the head in
premature baby or to control delivery of after
coming head of breech to lessen dangers of
sudden decompression.
16. IDENTIFICATION OF BLADE OF FORCEPS
• Take the blade of forceps
• Place it infront of maternal pelvis, tip of the
forceps directed towards maternal head,
concavity of pelvic curve directed toward the
midline of pelvis
• The blade which correspond to left side of
mother is left blade and right side right blade.
17. INDICATION OF FORCEPS
MATERNAL INDICATIONS-
-Maternal exhaustion following prolonged labour.
-Prolonged second stage of labour.
-Maternal distress as shown by maternal
tachycardia,dehydration,mild pyrexia
-Maternal medical disorder( like cardiac disease, severe
anaemia,tuberculosis, pregnancy induced hypertension,
eclampsia )
To shorten the second stage or obviate the need for
prolonged bearing down.
-Failure of decent or internal rotation for 2 hrs in
primigravida and 1hr in multigravida in second stage of
labour.
18. FETAL INDICATIONS
-Fetal distress in second stage of labour.
-After coming head of breech.
-Acute emergencies e.g. cord prolapse or cord
loops around the neck causing severe hypoxia.
19. PROLONGED SECOND STAGE OF LABOUR-(ACCORDING TO
ACOG 2002)
• IN NULLIPARA- more than three hour with or more
than two hour without regional analgesia.
• IN MULTIPARAS- more than two hours with or more
than one hour without regional anaesthesia.
20. Indications for operative vaginal delivery (RCOG
Guideline)
• Fetal - Presumed fetal compromise
• Maternal - To shorten and reduce the effects of the
second stage of labour on medical conditions-
• Cardiac disease -Class III or IV (N Y H Association
Classification)
• Hypertensive crises,
• Myasthenia gravis,
• Spinal cord injury
• Patients at risk of autonomic dysreflexia,
• Proliferative retinopathy
21. Indications for operative vaginal delivery (RCOG
Guideline) contd..
• Inadequate progress
• Nulliparous women – Lack of continuing progress for 3
hours (total of active and passive second-stage labour)
with regional anaesthesia, or 2 hours without regional
anaesthesia
• Multiparous women – lack of continuing progress for 2
hours (total of active and passive second-stage labour)
• With regional anaesthesia, or 1 hour without regional
anaesthesia
• Maternal fatigue/exhaustion
22. PREREQUISITES FOR FORCEPS APPLICATION
• The cervix must be completely dilated.
• The membranes must be ruptured.
• The head must be engaged.
• The fetus must be vertex, or present a face
with chin anterior.
• The position of the fetal head must be known.
23. PREREQUISITES FOR FORCEPS APPLICATION
contd..
• There must be no cephalopelvic disproportion.
• Bladder must be emptied.
• Adequate analgesia
• Experienced operator
• Verbal or written consent.
24. Prerequisites for operative vaginal delivery
(RCOG Green top guidelines)
• Head is ≤1/5th palpable per abdomen
• vaginal examination Vertex presentation.
• Cervix is fully dilated and the membranes ruptured.
• Exact position of the head can be determined so
proper placement of the instrument can be achieved.
• Assessment of caput and moulding.
• Pelvis is deemed adequate. Irreducible moulding may
indicate cephalo–pelvic disproportion.
25. Prerequisites for operative vaginal delivery (RCOG
Green top guidelines)contd..
• Preparation of mother- Clear explanation should be
given and informed consent obtained.
• Appropriate analgesia is in place for mid-cavity rotational
deliveries. This will usually be a regional block.
• A pudendal block may be appropriate, particularly in the
context of urgent delivery.
• Maternal bladder has been emptied recently. In-dwelling
catheter should be removed or balloon deflated.
• Aseptic technique.
26. Prerequisites for operative vaginal delivery (RCOG
Green top guidelines)contd..
• Preparation of staff- Operator must have the
knowledge, experience and skill necessary.
• Adequate facilities are available (appropriate
equipment, bed, lighting).
• Back-up plan in place in case of failure to deliver. When
conducting mid-cavity deliveries, theatre staff should be
immediately available to allow a caesarean section to
be performed without delay (less than 30 minutes).
28. OUTLET FORCEPS DELIVERY
FORCEPS APPLICATIONS-
• For application of left blade-two or more fingers of
right hand are introduced inside the left posterior
portion of vulva and into vagina beside the fetal
head.
• The handle of left branch is then grasped between
the thumb and two fingers of left hand and introduce
under the guidance of right hand .
• For application of right blade-two or more fingers of
left hand are introduced into the right posterior
position of vagina to serve as guide for right blade.
31. APPLICATIONS OF BLADES-
• The biparietal diameter corresponds to the
greatest distance between appropriately
applied blades.
• The head of fetus is perfectly grasped only
when long axis of blades corresponds to
occipitomental diameter.
• If one blade is applied over brow and other on
occiput, instrument cannot be locked and if
locked , blades will slip off when traction is
applied.
32. TRACTION
When it is certain that blades are applied
satisfactorily then gentle ,intermittent,
horizontal traction is exerted until perineum
begins to bulge.
• With traction when vulva is distended by the
occiput, an episiotomy may be given if
indicated.
33. TRACTION contd…
• Additional horizontal traction is applied, and
the handles are elevated, pointing directly
upwards as parietal bone emerge.
• As handles are raised, head is extended.
During birth of head, spontaneous delivery
should be simulated as closely as possible.
34. TRACTION contd..
• Traction should be intermittent ,and head
should be allowed to recede in intervals as in
spontaneous labour except in cases of fetal
bradycardia.
• It is preferable to apply traction only with each
uterine contraction.
• Maximum permissible force is 45 lb(20kg) in
the nullipara or 30 lb(13kg)in multipara.
35. Line of axis of traction(perpendicular to plane of pelvis)
1-high2-mid3-low4-outlet
36.
37. KIELLAND FORCEPS
Named after Kielland of Norway(rotational
forceps 1916), Specialised forceps with no
pelvic curve. Used in deep transverse arrest
with asynclitism of fetal head.
• Advantages over long curved forceps are-
-It can be used in unrotated vertex or face
presentation.
-facilitating grasping and correction of
asynclitic head because of sliding lock.
39. FAILED FORCEPS
When a deliberate attempt in vaginal delivery with
forceps has failed to expedite the process, it is called
failed forceps.
FORCEPS FAILED IF-
Fetal head does not advance with each pull.
Fetus is undelivered after three pulls with no descent
or after 30minutes
If forceps fails caesarian section is performed.
41. Vacuum Extraction (Ventouse)
• It is an instrumental device designed to assist
delivery by creating a vacuum between it and the
fetal scalp
• In the United states the device is referred to as
the vacuum extractor whereas in Europe it is
called as Ventouse- from the french word literally
meaning soft cup.
42. Historical background
• In 1705, Yonge described an attempted vaginal
delivery using a cupping glass
• In 1848 Simpson devised a bell shaped device called
an “air tractor vacuum extractor”
• In 1953 a metal cup extractor was developed by
Malmstrom .
43. Description
• Vacuum extractor is composed of:
• A specially designed cup with a diameter of 3, 4, 5 or
6 cm.
• A rubber tube attaching the cup to a glass bottle with
a screw in between to release the negative pressure.
• A manometer fitted in the mouth of the glass bottle
to declare the negative pressure.
• Another rubber tube connecting the bottle to a
suction piece which may be manual or electronic
creating a negative pressure that should not exceed -
0.8 kg per cm2.
46. Types of vacuum extractors
Vacuum extractors are divided on the
basis of the type of cup-
-metal or plastic
1.Metal cup vacuum extractors
2.Soft cup vacuum extractors
47. Metal cup
• The metal-cup vacuum extractor is a mushroom-
shaped metal cup varying from 40 to 60 mm in
diameter.
• Metal-cup vacuum extractors have a higher success
rate and easier cup placement in the
occipitoposterior (OP) position,
• The rigidity of metal cups can make application
difficult and uncomfortable, and their use is
associated with an increased risk of fetal scalp
injuries.
48. Soft cup
• Traditionally soft cups are bell or funnel
shaped.
• Soft-cup instruments can be used with a
manual vacuum pump or an electrical suction
device. Soft-cup vacuum extractors may be
disposable or reusable.
• Compared with metal-cup devices, soft-cup
vacuum extractors cause fewer neonatal scalp
injuries. However, these instruments have a
higher failure rate.
49. Indications of vacuum extraction
• Generally vacuum extraction is reserved for
fetuses who have attained a gestational age of
34 weeks.
• Otherwise, the indications and pre-requisites
for its use are the same as for forceps
delivery(American College of obstetricians and
Gynecologists
50. Contraindications
• Operator inexperience
• Inability to assess fetal position
• High station(above 0 station)
• Suspicion of cephalopelvic disproportion
• Other presentations than vertex.
• Premature fetus(<34 weeks).
• Intact membranes.
51. Pre-requisites of the Procedure
• Procedure should be explained to the patient and
consent should be taken
• Emotional support and encouragement
• Lithotomy position.
• Bladder should be emptied.
• Antiseptic measures for the vagina, vulva and
perineum.
• Vaginal examination to check pelvic capacity, cervical
dilatation, presentation, position, station and degree
of flexion of the head and that the membranes are
ruptured.
52. Application of the cup
• Identification of the flexion point-
-It is situated 3 cm in front of the posterior fontanelle.
-Centre of the cup should be overlying the flexion
point. This placement promotes flexion ,descent and
autorotation.
• If traction is directed from this point the fetal head is
flexed to the narrowest sub-occipitobregmatic
diameter(9.5 cm).
53.
54. Precautions-
• The largest cup that can be easily passed is
introduced sideways into the vagina by
pressing it backwards against the perineum.
• Be sure that there is no cervical or vaginal
tissues nor the umbilical cord or a limb in
complex presentation is included in the cup.
55.
56. Creating the negative pressure
• When using the rigid cups, the negative pressure is
gradually increased by 0.2 kg/cm2 every 2 minutes
until - 0.8 kg/cm2 is attained. This creates an
artificial caput within the cup.
• With soft cups negative pressure can be increased
to 0.8 kg/cm2 over as little as 1 minute
57.
58. Episiotomy
• An episiotomy may be needed for proper
placement of the cup
• If not, then delay the episiotomy till the head
stretches the perineum or perineum interferes
with the axis of traction
• This will minimize unnecessary blood loss.
59. Traction
• Traction should be intermittent and co-
ordinated with maternal expulsive efforts and
with uterine contractions.
• Traction should be in line of the pelvic axis and
perpendicular to the plane of the cup
60. Traction contd..
• Traction may be initiated by using a two
handed technique
• Fingers of one hand are placed against the
suction cup while the other hand grasps the
handle of the instrument
• This allows one to detect negative traction.
• Manual torque to the cup should be avoided
as it may cause cephalhaematoma and scalp
lacerations.
62. Traction contd..
• Between contractions, check for fetal heart
rate and proper application of the cup
• Check for sacral hand wedge if the head has
descended to the perineum with traction but
further progress is slow.
63. Release
• When the head is delivered the vacuum is
reduced as slowly as it was created using
the screw as this diminishes the risk of
scalp damage.
• The chignon should be explained to the
patient and the relatives.
64. Reapplication of the cup
If the cup detaches for the first time, reassess
the situation.
If favorable ,then reapply.
If cup detaches for the second time, reassess if
vaginal delivery is safe or move to caesarean
section
Caesarean section is necessary if there is
inadequate descent and rotation
65. Failure of vacuum
• Vacuum extraction is considered failed if-
-fetal head does not advance with each pull
-fetus is undelivered after 3 pulls with no
descent or after 30 minutes
-cup slips off the head twice at the proper
direction of pull with the maximum negative
pressure. (POP OFFS)
66. Advantages of Vacuum over Forceps
Regional Anaesthesia is not required so it is
preferred in cardiac and pulmonary patient.
The ventouse is not occupying a space beside the
head as forceps.
Less compression force (0.77 kg/cm2) compared
to forceps (1.3 kg/cm2) so injuries to the head
is less common.
Less genital tract lacerations.
Can be applied before full cervical dilatation.
It can be applied on non-engaged head.
67. Complications
Maternal
Perineal, vaginal ,labial, periurethral and cervical
lacerations.
Annular detachment of the cervix when applied
with incompletely dilated cervix.
Cervical incompetence and future prolapse if used
with incompletely dilated cervix.
68. Complications
Fetal
• Cephalohaematoma.
• Scalp lacerations and bruising
• Subgaleal hematomas
• Intracranial haemorrhage.
• Neonatal jaundice
• Subconjunctival haemorrhage
• Injury of sixth and seventh cranial nerves
• Retinal hemorrhage
• Fetal death