This document provides an overview of operative interventions in obstetrics, including operative vaginal delivery and caesarean section. It describes the indications, contraindications, prerequisites and techniques for operative vaginal delivery using forceps or vacuum extraction. The classifications, applications, and complications of forceps delivery are outlined. For vacuum extraction, the device components and application steps are explained. Caesarean section is defined and maternal, fetal, and fetomaternal indications listed. The document describes the classification of c-sections by urgency, types of abdominal incisions including low segment and classic, and the procedure steps. Complications of c-section are also summarized.
Placenta Previa is one type of Antepartum Hemorrhage and an obstetrical emergency too... So in health care management having knowledge regarding this topic is very important in Obstetrics.
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.
Placenta Previa is one type of Antepartum Hemorrhage and an obstetrical emergency too... So in health care management having knowledge regarding this topic is very important in Obstetrics.
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.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
This topic contains detailed description about labour, its definition, date of onset of labour, calculations of date of delivery, causes of onset of labour, physiology of normal labour, and events, clinical course and management of each stages of labour.
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.
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.
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
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
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
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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.
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4. 1) Operative Vaginal Delivery
▪ Definition : Delivery of a baby vaginally using an instrument (forceps/ vacuum device) for assistance.
Indications
Fetal Maternal
*Fetal compromise * Exhaustion
*Malposition of fetal head *Prolonged 2nd stage of labour
*Valsalva maneuver is contraindicated
* Pushing is ineffective because of maternal
neurologic or muscular disease.
- paraplegia/ tetraplegia / myasthenia gravis
6. PREREQUISITES
▪ Fetus alive
▪ Cervix is fully dilated.
▪ Membranes are ruptured.
▪ Fetal head descended and is engaged.
▪ Fetal presentation, position, station known.
▪ Gestational age >33wks to use vacuum devices.
10. CLASSIFICATION OF FORCEPS DELIVERY
▪ It is based on station and amount of
rotation which correlate with the degree of
difficulty and risk of the procedure.
▪ Station is measured in centimeters, −5 to 0
to +5. Rotation </> 45 degrees.
▪ Deliveries are categorized as outlet, low,
and midpelvic procedures.
11. Outlet forceps Low forceps Mid-forceps
•The leading point of the fetal skull
has reached the pelvic floor and at
or on the perineum
•The scalp is visible at the introitus
without separating the labia.
•Rotation does not exceed 45
degrees
•The leading point of the fetal skull
is ≥2 cm beyond the ischial spines,
but not on the pelvic floor (ie,
station is at least +2/5 cm ).
•Low forceps have two
subdivisions:
-Rotation ≤45 degrees
-Rotation >45 degrees
•The head is engaged(ie, at least 0
station), but the leading point of the
skull is <2 cm beyond the ischial spines
(ie, station is 0/5 cm or +1/5 cm).
13. Application of the Forceps
The left branch is held Place the right hand on the The left blade is introduced Repeat the same manoeuvre
in the left hand vertically left side, behind fetal head into the left side of the pelvis on the right side, using the
right hand & right branch
14. Lock the forceps Traction - horizontal Vertical traction As the fetal head is
reached, the forceps are
removed
15. FORCEPS DELIVERY : COMPLICATIONS
▪ FETAL COMPLICATIONS
– Injury to facial nerves
– Lacerations & bruising of the face and scalp
– Fractures of the face and skull
▪ MATERNAL COMPLICATIONS
– Tears of the genital tract may occur
– Trauma to soft tissue
18. ii)Vacuum Extraction - Dr.Mani Smk
▪ The vacuum device consists of the
– suction cup and the hand-pump.
▪ Check all connections before application.
▪ Assess the position of the fetal head.
▪ Identify the posterior fontanelle
Suction cup
Hand-pump
19. Application of the device
▪ Insert the cup into the vagina
in an oblique angle
▪ Apply the cup, with the center of the
cup over the flexion point.
▪ After applying the cup move a finger
around the cup to ensure there is no
maternal soft tissue (cervix or vagina)
within the rim.
20. ▪ With the pump, create a vacuum of 0.2 kg/cm2
negative pressure and check the application.
▪ Increase the vacuum to 0.8 kg/cm2 and check
the application.
▪ After maximum negative pressure, start
traction in the line of the pelvic axis and
perpendicular to the cup.
▪ Remove the cup when the fetal jaw is
reachable.
21. VACUUM EXTRACTION : COMPLICATIONS
▪ FETAL COMPLICATIONS
– Localized scalp oedema
– Cephalohematoma
– Retinal haemorrhage
– Scalp abrasions and lacerations
– Intracranial bleeding
▪ MATERNAL COMPLICATIONS
– Tears of the genital tract may occur due to entrapment of vaginal mucosa between suction
cup & fetal head
23. Forceps Vs Vacuum
▪ More likely to cause
maternal genital tract
trauma.
▪ Doesn’t need the help of the
mother, so done under
anaesthetics
▪ Can be used on premature
fetuses & to actively rotate
the fetal head
▪ More likely to cause fetal
trauma like:
cephalohaematoma & retinal
haemorrhage
▪ Need the mothers assistance
during delivery. So
anaesthetics are not given
▪ Fetal age:>33weeks of ges.
24. New Devices
▪ Odon device :
▪ Was introduced by theWHO for use in areas that
have limited or no access to cesarean birth.
▪ Made of film-like polyethylene material that creates a
sac filled with air that surrounds the entire fetal head
and enables extraction when traction is applied.
30. 2) Caesarean Section
▪ Definition : Surgical procedure in which a viable fetus is delivered through the
incisions of the mothers abdominal wall and uterus.
31. Indications for C-section
▪ It is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk.
MATERNAL FETAL FETO-MATERNAL
INDICATIONS INDICATIONS INDICATIONS
35. Classification according to Urgency
1CS – Emergency/crash
Immediate threat to the life of
the mother and fetus
2CS – Urgent
Maternal/fetal compromise
which is not immediately life
threatening
3CS- Scheduled
No maternal/fetal compromise
but needs early delivery
4CS – Elective
At optimal time for the mother
and the maternity team
Classification
according to
Urgency
Placental
abruption with
abnormal FHR
Cord prolapse
Failure to
progress with
pathological
CTG
Severe pre-
eclampsia
IUGR with poor
fetal function
tests
Twin pregnancy
with non-
cephalic first
twin
37. Low Segment Caesarean SectionPfannestielincision
• Slightly curved
horizontal incision 2-
3cm above the pubic
symphysis.
• Good cosmetic result
& less incidence of
herniation
• Less exposure
Joel-Cohenincision
• Straight horizontal
incision, 3 cm below
the line that joins the
anterior superior iliac
spines, and slightly
more cephalad than
Pfannenstiel
• Rely mostly on blunt
dissection to open the
abdomen
MaylardIncision
• Derived from
Pfannestiel incision.
• Rarely used
• Used when more
exposure is needed.
• Rectus muscle incised
38. Classic Incision
▪ This involves a vertical incision into the upper uterine
segment.
▪ Rarely performed
▪ Incision allows rapid delivery.
▪ This incision is made when incision-to-delivery time is
critical, as well as when a transverse incision may not
provide adequate exposure or may be too prone to
hematoma formation.
▪ Higher incidence of infection & herniation. Poor
cosmetic result.
40. Procedure
▪ Regional anesthesia - spinal is preferred. In some instances, use of
general anesthesia may be indicated.
▪ Position – supine with a 15 degree tilt of the theatre table
▪ A catheter is placed in the bladder
▪ Abdomen cleaned and surgically draped
41.
42. ▪ The uterine incision can be low transverse, classic vertical, low vertical,
J shaped or T shaped.
1 2 3
4 5 6
44. ▪ Some obstetricians repair the
uterus by uterine
exteriorization, and some
repair it while it is still in the
abdomen.
▪ The uterus is closed with one
or two layers of suture
▪ The layers of the abdominal
wall are sutured and then the
skin closed
45. Complications of Caesarean Section
Uterine lacerations
Heavy blood loss.(>1L)
Bladder injury.
Post anesthetic complications – respiratory difficulty
Wound Infection.
Deep venous thrombosis
Risk of incisional hernia
Rupture of uterus at the site of the scar in future pregnancies