Episiotomy - definition , purpose , indications, anesthesia,timing, Types, Steps of mediolateral episiotomy, precautions, complications and post operative care
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Episiotomy - definition , purpose , indications, anesthesia,timing, Types, Steps of mediolateral episiotomy, precautions, complications and post operative care
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Mannual removal of placenta is done under GA.
Patient placed in lithotomy position
Bladder is catheterized
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Episiotomy slideshare by dr alka mukherjee & dr apurva mukherjee msalka mukherjee
Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, it is recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.
Episiotomies—incisions made between the vagina and anus during childbirth—have long been a topic of debate among clinicians, researchers and advocates. Outdated clinical guidelines previously recommended the routine use of episiotomy to avoid natural vaginal tearing. Over the past two decades, a growing body of literature and increased advocacy efforts have led to a general consensus that episiotomy should not be conducted as a standard practice. Nevertheless, in many parts of the world, the majority of women still undergo episiotomy during childbirth.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Mannual removal of placenta is done under GA.
Patient placed in lithotomy position
Bladder is catheterized
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Episiotomy slideshare by dr alka mukherjee & dr apurva mukherjee msalka mukherjee
Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, it is recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.
Episiotomies—incisions made between the vagina and anus during childbirth—have long been a topic of debate among clinicians, researchers and advocates. Outdated clinical guidelines previously recommended the routine use of episiotomy to avoid natural vaginal tearing. Over the past two decades, a growing body of literature and increased advocacy efforts have led to a general consensus that episiotomy should not be conducted as a standard practice. Nevertheless, in many parts of the world, the majority of women still undergo episiotomy during childbirth.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
2. • According to legend, Julius Caesar was born by
this operation and hence the origin of the term
caesarean. ????
•Used to be
invariably fatal
• Most important modification was the lower
segment transverse incision. First done by kehrer
and popularized by Munro Kerr
3. INTRODUCTION
An operative procedure that is carried
out under anesthesia whereby the
fetus, placenta and membranes are
delivered through an incision in
abdominal wall and the uterus
Usually carried out after viability has
been reached i.e. 24-48 weeks of
gestation onwards.
4. The first operation performed on a
women is referred to as a primary
caesarean section.
When operation is performed in
subsequent pregnancies,it is called
repeat caesarean section.(C/S)
5. INCIDENCE:
The incidence of caesarean is steadly
raising.
During the last decade there has been
two-three folds rise in the inciddence
from the initial rate of about 10%.
Factors responsible are increased safety
of operation due to improved anesthesia,
availability of blood transfusion and
antibiotics.
Increased awareness of fetal well being
and idenification of risk factors have
caused reduction of difficult operation or
manipulative vaginal deliveries.
6. Indication for Caesarean section
. Absolute:
VaginalAtresia
Advanced carcinoma of cervix
Cervical or broad of contracted pelvis.
Severe degree of contracted pelvis.
. Relatives:
Cephalopelvic disproporton
Previous uterine scar
Fetal distress.
Malpresentations
Antepartum hemorrhage
Elderly primigravidae
Chronic hypertension
Diabetes
Pelvis atresia
9. Time of operation:
A. Elective caesarean section:
The term elective indicates that the
decision to deliver the baby by
caesarean has been made during the
pregnancy and before the onset of
labour.
It means pre-planning for doing
caesarean section.
Indication:
CPD
Placenta previa
Bad obstetric history
10. B. Emergency caesarean
delivery
When the operation is performed due
to unforseen complication arising
either during pregnancy or labour
without wasting time following the
decision.
Indication:
Cord prolapse
Uterine rupture
Eclampsia
Prolonged first stage of labour
Abnormal uterine contraction
11. Types of operation:
1. Lower segment caesarean section:
Is lesser muscular than the upper
segment of the uterus.
Transverse incision is made in the lower
segment this heals faster and sucessfully
than an incision in the upper segment of the
uterus.
There is less muscle and more fibrous
tissue in lower segment which reduces the
risk of rupture in a subsequent pregnancy.
Also known as “pfannensteel or bikini line
12. 2. Classical caesarean section:
In this baby is extracted through an
incision made in upper segment of
uterus.
Is rarely performed.
Operation is done only under forced
circumstances, such as:
carcinoma of cervix
Big fibroid on lower segment
constriction ring
lower segment is difficult or risky
example:placenta previa, adhesion due to
previous abdominal operation.
13. Classical CS - Disadvantages
• Chance of scar rupture more
• General peritonitis ,if infection occurs
14. LSCS SCAR CLASSICAL SCAR
Apposition Better Difficult
Healing in Better as the Lower Imperfect due to
puerperium segment is quiscent contraction and
retraction of upper
segment
Placental
implantation
May be over the scar much more likely
Rupture .5-2% 4-8%
Timing of rupture In labour In pregnancy and
labour
Infection Less chance More chance
16. LOWER SEGMENT CAESAREAN
SECTION
Preoperative actions
Valid informed consent
Inj Ranitidine 50 mg IV half to one hour
before the procedure
Inj Metoclopramide 10 mg IV half to one
hour before the procedure
Stomach should be empty
Bladder should be catheterized
Fetal presentation, position and FHS should
be checked
17. LOWER SEGMENT CAESAREAN SECTION
ANAESTHESIA
Spinal
Epidural
GA
POSITION
Dorsal position
15 degree lateral tilt to prevent supine hypotension /
venocaval compression may be given
18. Operation procedure:
The non gravid uterus is a pelvic organ closely
covered by a layer of pelvic peritoneum.
As pregnancy advances, the uterus grows up into
the abdomen and this peritoneum rises up with the
uterus and comes into contact with the abdominal
peritoneum. Each of these layers must be incision
and repaired.
The abdominal peritoneum is situated below the
abdominal muscles layer.
The anatominal layers are:
a) Skin
b) Fat
c) Rectus sheath
d) Rectus abdominis
e) Abdominal peritoneum
f) pelvic peritoneum
g) Uterine muscles
19. The operation most commonly carried out
is the lower segment caesarean section.
The lower segment incision is in the less
muscular and active part of the uterus and
heals better.
The main reason for preferring the lower
uterine segment technique is the reduced
incidence of dehiscent pregnancy.
The abdomen is opened and the loose
folds of the peritoneum over the anterior
aspect of the lower uterine segment and
above the bladder is incised. The operator
continues so incise this further to visualize
the fundus of bladder which is then pushed
down and away from the surgeon.
20. The surgeon direct the fetal head out while
the assistant applies fundal pressure to hip
the delivery of the baby.
Oxytocins may be given by the anesthetist
after delivery of the baby and clamping the
cord.
When the baby and placental have been
delivered the uterus is sutured.
This is usualy done in two layers. The
peritoneum then be clased over uterine
wound to exclude it from the peritoneal
cavity.
The rectus sheath is closed then the layers
of fat and finally the skin is sutured with the
surgeons choice of materials; commonly
21. Nursing Management
A. Pre-operative management:
Patient should be physically prepared
i.e.abdomen,back ,private parts and upper
part os thigh are shaved and cleaned.
Prepare mother psychologically by
providing assurance a nd explanning the
indication,procedure and need of
caesarean section.
Administration of IV infusion of 50%
dextrose to avoid hypotension following
spinal anaesthesia,the infusion line is
maintained patent by an intra venous
cannula.
Blood grouped and cross matched for
emergency requirement.
22. Bladder should be empty by inserting
foleys catheter.This may be done
before and after induction of
anaesthesia.
Mother should be in NPO for about 8
hours.
Patient should be in clean
gown,valuable ornament should be
taken off and all make up should be
removed.
If elective caesarean section then
Ranitidine 150mg should be given
orally in the night before and repeated
one hour before surgery to prevent
23. B. Post operative care :
1. Immediate care (4-6 hours):
• In the immediate recovery period,the blood
pressure is recorded in every 2 hourly.
• The wound must be inspected half hourly
to detect any blood loss.
• The lochia are inspected and drainage
should be small initially Following general
anaesthesia, the women is nursed in left
lateral or recovery position until she is fully
conscious.
• Analgesic is given as prescribed.
24. 2. First 24 hours:
IV fluids are continued,blood transfusion is helpful
in anemia mothers.
Parental antibiotic is usually given for 1st 48
hours,analgesics is the form of pethidine 75-100mg
are given as needed.
Ambulation is encouraged following day of surgery
and baby is given to mother.
3. After 24 hours:
TPR are usually checked every 4 hourly
Orally feeding is started with clear liquid and then
advanced to normal diet and IV fluid are continued
for about 48 hours.
Catheter may be removed on following day when
the women is able to get up to the toilet. She should
be helped to get out of bed.
The mother must be encouraged to take rest and
provide care to the baby and should breast feed the
25. Complication
Mother:
post partum hemorrhage related to uterine
atony and rarely blood coagulation
disorders.
Shocks related to blood loss.
Anesthesia hazards
Sepsis, secondary PPH.
Thrombosis
Lung infection post.
26. Late compilcation:
Menstrual irregularity
Chronic pelvic pain
Backache
Fetus:
Iatrogenic prematurity.
Respiratory distress syndrome.
Injury to baby due to surgical knife.
Birth asphyxia due to anaesthesia.
