This document defines induction of labor as artificially initiating uterine contractions before spontaneous labor begins. It lists several medical indications for induction, such as post-term pregnancy, preeclampsia, IUGR, and others. It also discusses contraindications and complications of induction. Several methods of induction are described, including pharmacological methods using prostaglandins and oxytocin, as well as non-pharmacological methods like membrane stripping, amniotomy, and balloon catheters. Factors that increase the success of induction like bishop score and gestational age are also summarized.
This document discusses obstructed labor, defined as arrested progression of the presenting fetal part during labor due to mechanical obstruction. Causes include faults in the pelvic passageway or fetus. Anatomical changes in the mother include pathological retraction rings and trauma to organs. Effects on the mother are immediate like exhaustion, infection, and hemorrhage or remote like fistulas. The fetus is at risk of asphyxia, infection, and acidosis. Clinical features include continuous pain, exhaustion, tender abdomen, and swollen vagina. Prevention focuses on antenatal detection and timely intervention in prolonged labor. Treatment principles are to relieve the obstruction, combat dehydration and infection, and control sepsis through fluid resuscitation, antibiotics,
Dr. Rakhi Gajbhiye is a director of Mauli Women's Hospital in Nagpur, India. She has published 9 papers in journals and contributed a chapter to a book on hysteroscopy. She is a member of several medical organizations and delivers talks at conferences.
The document discusses various surgical interventions for postpartum hemorrhage (PPH) when medical or mechanical methods have failed. It describes compression sutures like the B-Lynch suture and Hayman suture, as well as ligation of the uterine, ovarian, and internal iliac vessels. Hysterectomy is mentioned as a last resort. Complications of compression sutures and the procedures for
Shoulder dystocia is an obstetric emergency that occurs when the baby's anterior shoulder becomes trapped behind the pubic bone during childbirth after delivery of the head. Risk factors include previous shoulder dystocia, large baby size (macrosomia), diabetes, and certain complications during labor like prolonged pushing. Diagnosis involves difficulty delivering the baby's head or shoulders with normal traction. Management begins by calling for help and stopping pushing, and uses maneuvers like McRoberts position and suprapubic pressure to widen the pelvis and disimpact the shoulder. If these fail, internal maneuvers are attempted to rotate the baby before considering more extreme options. Complications can include maternal and fetal injuries.
This document defines shoulder dystocia and describes the risk factors, diagnosis, management, and complications. Shoulder dystocia is an obstetric emergency where the fetal shoulders are impacted at the birth canal after delivery of the head. Risk factors include previous shoulder dystocia, macrosomia, and prolonged labor. Diagnosis involves failure of shoulder delivery after head delivery. Management begins with non-traction maneuvers like McRoberts position and suprapubic pressure, followed by rotational maneuvers if needed. Complications include brachial plexus injury, fractures, and hypoxic ischemic encephalopathy.
This document describes forceps-assisted deliveries. It defines obstetric forceps as a double-bladed metal instrument used to extract the fetal head. It describes the parts of forceps including the blades, shanks, locks and handles. It discusses different types of forceps and their uses. It outlines the indications, prerequisites, technique and contraindications for a forceps-assisted delivery. Key steps include inserting the blades one at a time, applying traction in line with uterine contractions to deliver the baby. Training and experience of the operator are important to minimize risks.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
This document defines induction of labor as artificially initiating uterine contractions before spontaneous labor begins. It lists several medical indications for induction, such as post-term pregnancy, preeclampsia, IUGR, and others. It also discusses contraindications and complications of induction. Several methods of induction are described, including pharmacological methods using prostaglandins and oxytocin, as well as non-pharmacological methods like membrane stripping, amniotomy, and balloon catheters. Factors that increase the success of induction like bishop score and gestational age are also summarized.
This document discusses obstructed labor, defined as arrested progression of the presenting fetal part during labor due to mechanical obstruction. Causes include faults in the pelvic passageway or fetus. Anatomical changes in the mother include pathological retraction rings and trauma to organs. Effects on the mother are immediate like exhaustion, infection, and hemorrhage or remote like fistulas. The fetus is at risk of asphyxia, infection, and acidosis. Clinical features include continuous pain, exhaustion, tender abdomen, and swollen vagina. Prevention focuses on antenatal detection and timely intervention in prolonged labor. Treatment principles are to relieve the obstruction, combat dehydration and infection, and control sepsis through fluid resuscitation, antibiotics,
Dr. Rakhi Gajbhiye is a director of Mauli Women's Hospital in Nagpur, India. She has published 9 papers in journals and contributed a chapter to a book on hysteroscopy. She is a member of several medical organizations and delivers talks at conferences.
The document discusses various surgical interventions for postpartum hemorrhage (PPH) when medical or mechanical methods have failed. It describes compression sutures like the B-Lynch suture and Hayman suture, as well as ligation of the uterine, ovarian, and internal iliac vessels. Hysterectomy is mentioned as a last resort. Complications of compression sutures and the procedures for
Shoulder dystocia is an obstetric emergency that occurs when the baby's anterior shoulder becomes trapped behind the pubic bone during childbirth after delivery of the head. Risk factors include previous shoulder dystocia, large baby size (macrosomia), diabetes, and certain complications during labor like prolonged pushing. Diagnosis involves difficulty delivering the baby's head or shoulders with normal traction. Management begins by calling for help and stopping pushing, and uses maneuvers like McRoberts position and suprapubic pressure to widen the pelvis and disimpact the shoulder. If these fail, internal maneuvers are attempted to rotate the baby before considering more extreme options. Complications can include maternal and fetal injuries.
This document defines shoulder dystocia and describes the risk factors, diagnosis, management, and complications. Shoulder dystocia is an obstetric emergency where the fetal shoulders are impacted at the birth canal after delivery of the head. Risk factors include previous shoulder dystocia, macrosomia, and prolonged labor. Diagnosis involves failure of shoulder delivery after head delivery. Management begins with non-traction maneuvers like McRoberts position and suprapubic pressure, followed by rotational maneuvers if needed. Complications include brachial plexus injury, fractures, and hypoxic ischemic encephalopathy.
This document describes forceps-assisted deliveries. It defines obstetric forceps as a double-bladed metal instrument used to extract the fetal head. It describes the parts of forceps including the blades, shanks, locks and handles. It discusses different types of forceps and their uses. It outlines the indications, prerequisites, technique and contraindications for a forceps-assisted delivery. Key steps include inserting the blades one at a time, applying traction in line with uterine contractions to deliver the baby. Training and experience of the operator are important to minimize risks.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
This document discusses uterine compression sutures as a technique to control postpartum hemorrhage. It begins by explaining that postpartum hemorrhage is the leading cause of maternal mortality worldwide. Uterine compression sutures involve applying sutures externally to the uterus in various patterns to promote uterine contraction and compression of blood vessels, similar to manual compression. The sutures act as a brace for the uterus. Indications for uterine compression sutures include atonic PPH, abnormal placentation, coagulopathy, and as prophylaxis for high risk patients. Both absorbable and non-absorbable suture materials can be used.
1) The partograph is a graphical record used to monitor the progress of labour and detect abnormalities through charting cervical dilation, fetal descent, contractions, and fetal/maternal conditions.
2) It consists of 3 sections - fetal condition, labour progress, and maternal condition - to provide an objective assessment of factors indicating normal vs obstructed labour.
3) Abnormal progress detected by crossing the alert line (1cm dilation/hour) or action line requires reassessment and management decisions to prevent complications.
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Induction, augmentation and trial of laborNisha Ghimire
The document discusses induction of labor, including definitions, methods, and indications. It describes the three main methods of induction - medical, surgical, and combined. The medical method involves prostaglandins like misoprostol and oxytocin to induce contractions. The surgical method is artificial rupture of membranes. The combined method uses both medical induction and rupture of membranes. Some common indications for induction include post-term pregnancy, preeclampsia, and fetal growth restriction. Risks of induction include uterine hyperstimulation and failed induction requiring c-section. Strict monitoring is important during any induction procedure.
This document provides information about female sterilization procedures. It discusses:
1. The anatomy of the fallopian tubes and their physiological functions.
2. The criteria for patient selection including age, number of children, prior sterilization history, and mental capacity.
3. Details of the counseling process and common surgical techniques like Pomeroy's and Uchida methods.
4. Post-operative care and potential complications. Hysteroscopic methods like Essure coils are also summarized.
1) Normal labour is defined as spontaneous onset of labour at term, with a vertex presentation and natural termination with minimal intervention.
2) It involves three stages: first stage of cervical dilation from 0-10cm; second stage of fetal expulsion; third stage of placental delivery.
3) The first stage has two phases - a latent phase of slow dilation to 3-4cm and an active phase of rapid dilation to 10cm. It is influenced by uterine contractions, membrane status, and fetal position.
Shoulder dystocia is when the fetal shoulders become lodged at the maternal pelvis after delivery of the head, occurring in 0.2-2% of births. Risk factors include maternal diabetes, obesity, macrosomia, and prior shoulder dystocia. Management involves calling for help, applying suprapubic pressure and the McRoberts maneuver to widen the pelvis, and rotating the shoulders using maneuvers like Woods screw or Rubin. If unsuccessful, procedures include delivering the posterior arm or rarely symphysiotomy. Fetal risks are brachial plexus injury, fractures, and hypoxic brain injury. Maternal risks include perineal tears and postpartum hemorrhage. Prevention focuses
The document discusses uterine contractions during labor and delivery. It defines the normal frequency and intensity of contractions. It describes two pacemakers in the uterus that generate contractions and the normal basal tone and peak pressure of contractions. It then discusses different abnormalities that can occur with contractions, including abnormal polarity, hypertonic dysfunction, precipitate labor in the absence of obstruction, tonic contractions and Bandl's ring in the presence of obstruction, hypotonic dysfunction/uterine inertia, contraction rings, and cervical dystocia. It provides details on each abnormality, their causes, and methods of management.
This document discusses multiple pregnancy, including twins and higher order multiples. It covers the incidence, risks, types (dizygotic/monozygotic), complications, diagnosis and management of twin pregnancies. Key points include:
- Twins account for a significant percentage of preterm births and low birthweight infants.
- Determining chorionicity and zygosity is important for risk assessment and management.
- Monochorionic twins carry risks of complications like twin-twin transfusion syndrome requiring specialized care.
- Complications include preterm birth, growth discordance, fetal demise of one twin, and others. Careful monitoring and possible interventions may be needed.
The document discusses guidelines for induction of labor including:
1) Common reasons for induction of labor and risks/benefits that should be discussed with patients. Patients should be informed of alternative options if they decline induction.
2) What to discuss at the 38 week visit including membrane sweeps and the timing of induction between 41-42 weeks or for other reasons like preterm rupture of membranes.
3) Methods of induction including membrane sweeps, pharmacological agents like prostaglandins, amniotomy, and Foley catheter placement. Risks of induction like uterine hyperstimulation and failed induction are also addressed.
The document discusses various methods for managing pelvic organ prolapse, including preventive measures, conservative treatments like pessary use, and different surgical procedures for correcting prolapse of the anterior vaginal wall, posterior vaginal wall, uterus, and vaginal vault depending on factors like patient age and desire for future fertility or menstruation. Conservative options have limitations while surgery aims to relieve symptoms, restore anatomy, and sexual function with various procedures for different types and degrees of prolapse.
The document discusses labor and delivery. It defines labor as the process of expelling the fetus through the birth canal. Normal labor involves regular contractions leading to full cervical dilation and delivery of the fetus without complications for the mother or baby. Difficult labor is referred to as dystocia. The birth canal is divided into the pelvic inlet, cavity, and outlet. Fetal positioning includes engagement, descent, flexion, internal rotation, extension, and restitution. A cardiotocography (CTG) machine monitors the fetal heart rate and uterine contractions during labor.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Forceps delivery Guest lecture presented at thr West Zone YUVA FOGSI Udaipur in July 2018, Dfination, Clasification, Prerequisites, Indications, Contraindications, Complication Maternal and Fetal,
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
This document discusses clinical pelvimetry and forceps-assisted vaginal delivery. It begins by outlining the objectives and key anatomical features assessed in a clinical pelvimetry exam. It then discusses the different types of forceps, indications for their use, application techniques, and complications. It emphasizes the importance of training residents on forceps use through lectures, workshops and opportunities to apply different forceps during cesarean deliveries in order to graduate with skills for operative vaginal delivery.
This document provides an overview of vaginal techniques that can be used for sexual positions. It discusses single and multiple partner positions and notes that some positions are more complex than others. The document outlines different physical arrangements and interactions that can be engaged in for pleasure and intimacy.
This document defines and discusses transverse lie, which occurs when the long axis of the fetus lies perpendicular to the maternal spine. Key points include:
- Transverse lie has an incidence of about 1 in 300 births and is more common in multiparous women and preterm fetuses.
- Diagnosis involves abdominal and vaginal exams to identify the fetal parts in unusual positions.
- Spontaneous delivery is very rare and management typically involves external cephalic version to change the lie, followed by induction if successful. Cesarean delivery is required if version fails or the fetus is in distress.
This document provides information on assisted vaginal delivery methods. It defines operative vaginal delivery as using forceps or vacuum extraction to expedite delivery while minimizing risks. Safety criteria for both methods include full dilation, engagement and adequate analgesia. Forceps are suitable when the head is well applied while vacuum is preferred for less trauma but has a higher failure rate. Complications can include maternal and fetal injury resulting from trauma. The choice of instrument depends on factors like position, experience and patient preference.
This document discusses various operative deliveries including vacuum extraction, forceps delivery, destructive operations, and cesarean section. It describes the indications, contraindications, procedures and complications for each type of delivery. Vacuum extraction is preferable to forceps when possible as it causes less trauma, however forceps allow for rotation and work in more positions. Destructive operations like craniotomy or decapitation are used when the fetus is dead to allow easier passage through the birth canal. Cesarean section is described as delivery through abdominal and uterine incisions, with the most common indications being failure to progress, previous c-section, nonreassuring fetal status and malpresentation.
This document discusses uterine compression sutures as a technique to control postpartum hemorrhage. It begins by explaining that postpartum hemorrhage is the leading cause of maternal mortality worldwide. Uterine compression sutures involve applying sutures externally to the uterus in various patterns to promote uterine contraction and compression of blood vessels, similar to manual compression. The sutures act as a brace for the uterus. Indications for uterine compression sutures include atonic PPH, abnormal placentation, coagulopathy, and as prophylaxis for high risk patients. Both absorbable and non-absorbable suture materials can be used.
1) The partograph is a graphical record used to monitor the progress of labour and detect abnormalities through charting cervical dilation, fetal descent, contractions, and fetal/maternal conditions.
2) It consists of 3 sections - fetal condition, labour progress, and maternal condition - to provide an objective assessment of factors indicating normal vs obstructed labour.
3) Abnormal progress detected by crossing the alert line (1cm dilation/hour) or action line requires reassessment and management decisions to prevent complications.
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Induction, augmentation and trial of laborNisha Ghimire
The document discusses induction of labor, including definitions, methods, and indications. It describes the three main methods of induction - medical, surgical, and combined. The medical method involves prostaglandins like misoprostol and oxytocin to induce contractions. The surgical method is artificial rupture of membranes. The combined method uses both medical induction and rupture of membranes. Some common indications for induction include post-term pregnancy, preeclampsia, and fetal growth restriction. Risks of induction include uterine hyperstimulation and failed induction requiring c-section. Strict monitoring is important during any induction procedure.
This document provides information about female sterilization procedures. It discusses:
1. The anatomy of the fallopian tubes and their physiological functions.
2. The criteria for patient selection including age, number of children, prior sterilization history, and mental capacity.
3. Details of the counseling process and common surgical techniques like Pomeroy's and Uchida methods.
4. Post-operative care and potential complications. Hysteroscopic methods like Essure coils are also summarized.
1) Normal labour is defined as spontaneous onset of labour at term, with a vertex presentation and natural termination with minimal intervention.
2) It involves three stages: first stage of cervical dilation from 0-10cm; second stage of fetal expulsion; third stage of placental delivery.
3) The first stage has two phases - a latent phase of slow dilation to 3-4cm and an active phase of rapid dilation to 10cm. It is influenced by uterine contractions, membrane status, and fetal position.
Shoulder dystocia is when the fetal shoulders become lodged at the maternal pelvis after delivery of the head, occurring in 0.2-2% of births. Risk factors include maternal diabetes, obesity, macrosomia, and prior shoulder dystocia. Management involves calling for help, applying suprapubic pressure and the McRoberts maneuver to widen the pelvis, and rotating the shoulders using maneuvers like Woods screw or Rubin. If unsuccessful, procedures include delivering the posterior arm or rarely symphysiotomy. Fetal risks are brachial plexus injury, fractures, and hypoxic brain injury. Maternal risks include perineal tears and postpartum hemorrhage. Prevention focuses
The document discusses uterine contractions during labor and delivery. It defines the normal frequency and intensity of contractions. It describes two pacemakers in the uterus that generate contractions and the normal basal tone and peak pressure of contractions. It then discusses different abnormalities that can occur with contractions, including abnormal polarity, hypertonic dysfunction, precipitate labor in the absence of obstruction, tonic contractions and Bandl's ring in the presence of obstruction, hypotonic dysfunction/uterine inertia, contraction rings, and cervical dystocia. It provides details on each abnormality, their causes, and methods of management.
This document discusses multiple pregnancy, including twins and higher order multiples. It covers the incidence, risks, types (dizygotic/monozygotic), complications, diagnosis and management of twin pregnancies. Key points include:
- Twins account for a significant percentage of preterm births and low birthweight infants.
- Determining chorionicity and zygosity is important for risk assessment and management.
- Monochorionic twins carry risks of complications like twin-twin transfusion syndrome requiring specialized care.
- Complications include preterm birth, growth discordance, fetal demise of one twin, and others. Careful monitoring and possible interventions may be needed.
The document discusses guidelines for induction of labor including:
1) Common reasons for induction of labor and risks/benefits that should be discussed with patients. Patients should be informed of alternative options if they decline induction.
2) What to discuss at the 38 week visit including membrane sweeps and the timing of induction between 41-42 weeks or for other reasons like preterm rupture of membranes.
3) Methods of induction including membrane sweeps, pharmacological agents like prostaglandins, amniotomy, and Foley catheter placement. Risks of induction like uterine hyperstimulation and failed induction are also addressed.
The document discusses various methods for managing pelvic organ prolapse, including preventive measures, conservative treatments like pessary use, and different surgical procedures for correcting prolapse of the anterior vaginal wall, posterior vaginal wall, uterus, and vaginal vault depending on factors like patient age and desire for future fertility or menstruation. Conservative options have limitations while surgery aims to relieve symptoms, restore anatomy, and sexual function with various procedures for different types and degrees of prolapse.
The document discusses labor and delivery. It defines labor as the process of expelling the fetus through the birth canal. Normal labor involves regular contractions leading to full cervical dilation and delivery of the fetus without complications for the mother or baby. Difficult labor is referred to as dystocia. The birth canal is divided into the pelvic inlet, cavity, and outlet. Fetal positioning includes engagement, descent, flexion, internal rotation, extension, and restitution. A cardiotocography (CTG) machine monitors the fetal heart rate and uterine contractions during labor.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Forceps delivery Guest lecture presented at thr West Zone YUVA FOGSI Udaipur in July 2018, Dfination, Clasification, Prerequisites, Indications, Contraindications, Complication Maternal and Fetal,
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
This document discusses clinical pelvimetry and forceps-assisted vaginal delivery. It begins by outlining the objectives and key anatomical features assessed in a clinical pelvimetry exam. It then discusses the different types of forceps, indications for their use, application techniques, and complications. It emphasizes the importance of training residents on forceps use through lectures, workshops and opportunities to apply different forceps during cesarean deliveries in order to graduate with skills for operative vaginal delivery.
This document provides an overview of vaginal techniques that can be used for sexual positions. It discusses single and multiple partner positions and notes that some positions are more complex than others. The document outlines different physical arrangements and interactions that can be engaged in for pleasure and intimacy.
This document defines and discusses transverse lie, which occurs when the long axis of the fetus lies perpendicular to the maternal spine. Key points include:
- Transverse lie has an incidence of about 1 in 300 births and is more common in multiparous women and preterm fetuses.
- Diagnosis involves abdominal and vaginal exams to identify the fetal parts in unusual positions.
- Spontaneous delivery is very rare and management typically involves external cephalic version to change the lie, followed by induction if successful. Cesarean delivery is required if version fails or the fetus is in distress.
This document provides information on assisted vaginal delivery methods. It defines operative vaginal delivery as using forceps or vacuum extraction to expedite delivery while minimizing risks. Safety criteria for both methods include full dilation, engagement and adequate analgesia. Forceps are suitable when the head is well applied while vacuum is preferred for less trauma but has a higher failure rate. Complications can include maternal and fetal injury resulting from trauma. The choice of instrument depends on factors like position, experience and patient preference.
This document discusses various operative deliveries including vacuum extraction, forceps delivery, destructive operations, and cesarean section. It describes the indications, contraindications, procedures and complications for each type of delivery. Vacuum extraction is preferable to forceps when possible as it causes less trauma, however forceps allow for rotation and work in more positions. Destructive operations like craniotomy or decapitation are used when the fetus is dead to allow easier passage through the birth canal. Cesarean section is described as delivery through abdominal and uterine incisions, with the most common indications being failure to progress, previous c-section, nonreassuring fetal status and malpresentation.
This document provides an overview of vacuum-assisted delivery, including:
1) The introduction, instruments, advantages, indications, techniques, rules, procedures, disadvantages, contraindications, and complications of vacuum-assisted delivery.
2) Details on the components of vacuum devices, classification of assisted delivery, advantages of vacuum over forceps, and the 10 step procedure for vacuum delivery from asking for help to releasing the vacuum once the baby's jaw can be reached.
3) Potential maternal and fetal complications that can arise from technical errors or other issues with the procedure. Management, documentation and references are also covered.
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
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.
Operative vaginal delivery using forceps or vacuum extraction can assist with prolonged labor and reduce caesarean sections if performed properly by selecting appropriate cases. Risks include maternal and fetal injuries from trauma. Vacuum extraction is generally safer and less technically demanding than forceps delivery. Both instruments carry risks if improperly used but complications are usually due to technique rather than the instrument itself. Careful patient selection, aseptic technique, and gentle controlled traction are necessary to minimize risks from these procedures.
The document discusses the advantages and disadvantages of vacuum extraction versus forceps for assisted vaginal delivery. It summarizes that vacuum extraction is associated with less maternal trauma, less need for anesthesia, and lower failure rates compared to forceps. However, vacuum extraction may be associated with a higher risk of cephalhematoma, retinal hemorrhage, and intracranial hemorrhage in the baby. The choice of extraction method depends on the clinical situation and experience of the attending physician.
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.
The document discusses instrumental vaginal deliveries such as forceps delivery and vacuum extraction. It notes that these procedures are becoming less common due to the safety of c-sections and higher expectations. Risks to both mother and baby are outlined. Safe practices including indications, prerequisites, and avoiding errors are presented to minimize risks when these procedures are necessary. The overall goal for any delivery is a healthy outcome for both mother and baby.
Instrumental delivery refers to vaginal birth assisted by forceps or vacuum extraction. Indications for instrumental delivery include suspected fetal compromise, failure to progress in labor, or medical risks that contraindicate prolonged pushing. Operative vaginal delivery requires careful patient evaluation and selection of the appropriate instrument. While instrumental delivery can assist difficult births, both forceps and vacuum extraction carry risks of complications for both mother and baby if not performed correctly. Thorough training and strict adherence to safety guidelines are necessary to minimize risks when providing this intervention.
Vacuum delivery is one of the most important art to learn in labour ward. Kiwi is a simplified vacuum device. Mastering the techniques these devices can achieve good outcomes.
This document outlines vacuum-assisted vaginal delivery (VVD). It defines VVD as using a suction cup on the fetal head attached to a vacuum pump to provide traction during contractions. It classifies VVD by fetal station and lists indications such as prolonged second stage or fetal distress. Contraindications include non-vertex presentation or cephalopelvic disproportion. The document details prerequisites, provides a mnemonic for the procedure, discusses complications, and notes advantages like less force on the fetal head and disadvantages like requiring maternal effort.
This document provides information on operative vaginal delivery and Caesarean section. It discusses the indications, techniques, risks and complications of forceps delivery, vacuum extraction and Caesarean section. Forceps delivery risks maternal and fetal trauma while vacuum extraction carries lower risks of trauma but higher risks of failure. Caesarean section has a higher mortality rate than vaginal delivery but may be necessary when risks to the mother and baby outweigh vaginal delivery risks.
This document provides an overview of instrumental deliveries including forceps delivery, vacuum extraction, and destructive vaginal deliveries. It defines instrumental deliveries as births assisted by forceps or vacuum and notes their indications include hastening delivery when labor is obstructed or prolonged. Complications of instrumental deliveries for both mother and baby are described. The document then details the types, prerequisites, applications and complications of forceps delivery, vacuum extraction, and various destructive vaginal procedures.
This document provides an overview of assisted vaginal deliveries presented by Dr. Kabelenga. It defines assisted vaginal delivery as using vacuum extraction or forceps to help with vaginal birth. Vacuum extraction uses suction cups applied to the fetal head, while forceps use curved blades to grasp the head. Both have indications such as dystocia and fetal distress. Prerequisites for their use include engagement and cervical dilation. Complications can include birth canal trauma or fetal scalp injuries. The document compares vacuum extraction and forceps, noting advantages of each technique.
The document describes various methods for uterine evacuation following an incomplete abortion. It focuses on manual vacuum aspiration (MVA), which uses a hand-held syringe to apply suction through a plastic cannula and evacuate the contents of the uterus. The document outlines the key steps for performing MVA, including preparing instruments, dilating the cervix, inserting the cannula, applying suction, and inspecting the tissue. MVA is described as a safe, effective and low-cost option that does not require electricity and can be used where resources are limited.
Embryo Transfer (ET) . Lifecare Centre Dr Sharda Jain Dr. Jyoti Agarwal Dr. ...Lifecare Centre
This document discusses embryo transfer (ET) technique, which is the final and most crucial step of in vitro fertilization (IVF). It provides tips for an optimal ET, including performing a mock or trial transfer, removing cervical mucus, using a soft catheter under ultrasound guidance, avoiding touching the fundus or causing uterine contractions, and ensuring the catheter tip is placed 10-20mm from the fundus for best pregnancy outcomes. Proper ET technique can significantly improve pregnancy rates compared to poor technique.
Operative procedures in obstetrics often require aseptic techniques and protocols. Forceps deliveries and vacuum extractions help deliver babies when natural delivery is not possible or advisable. Forceps come in various shapes and sizes and are applied at different levels of the fetal head. Caesarean sections are performed when delivery through the birth canal would endanger the mother or baby. Lower segment incisions are now preferred. Destructive procedures like craniotomy perforate the fetal skull to allow delivery of a dead baby when labor is obstructed.
This document discusses prolonged labor, obstructed labor, and dystocia caused by fetal anomalies. Prolonged labor is defined as the combined first and second stage of labor exceeding 18 hours. It can be caused by issues with cervical dilation, fetal descent, uterine contractions, or pelvic and fetal factors. Obstructed labor occurs when descent is arrested due to a mechanical obstruction in the birth canal or fetus. This can lead to exhaustion, dehydration, acidosis, and infection for the mother. Fetal risks include hypoxia, infection, head molding issues, and increased need for operative delivery. Prevention focuses on identifying risk factors. Treatment involves evaluating the cause and deciding between augmentation, assisted delivery, or C-
Similar to Operative Vaginal Deliveries - 2021 (20)
This document discusses obesity in obstetrics. It defines classifications of obesity and notes that obesity prevalence is around 30-40% in men and women. Key points are that adipose tissue communicates with other tissues via adipokines, which can enhance or reduce insulin sensitivity. Obesity is associated with conditions like metabolic syndrome and nonalcoholic fatty liver disease. It also discusses obesity-related risks in pregnancy like gestational diabetes and complications during delivery. Lifestyle changes and bariatric surgery are described as treatment approaches for obesity.
This document discusses multiple pregnancy, specifically twin pregnancies. It covers zygosity, mechanisms of twinning, chorionicity, complications of multiple pregnancies, and prenatal care considerations. The main points are:
- Twin births account for 3% of live births and 97% of multiple births. Zygosity can be monozygotic (identical) or dizygotic (fraternal) depending on the fertilization of eggs.
- Complications of multiple pregnancies include higher rates of preeclampsia, preterm birth, and low birth weight. Prenatal care involves increased supplementation, more frequent checkups, and testing of fetal well-being starting at 28 weeks.
- Specific
History & Physical Examination in OBGYNOBGYN Notes
This document outlines the components and structure of a thorough history and physical examination. It begins by listing demographic information about the patient such as name, age, sex, address, and marital status. It then describes the chief complaint, history of present illness, past medical history, social history, family history, review of systems, and physical examination in detail. The goal is to provide all relevant information about the patient's health in an organized manner.
Thalassemia is a blood disorder caused by reduced or absent globin chain production, leading to anemia. It is classified as alpha or beta thalassemia depending on the deficient chain. Common in areas like Southeast Asia and the Mediterranean. Diagnosis involves blood tests showing hypochromic microcytic anemia and globin gene testing. Symptoms range from mild to severe depending on the number of defective genes. The most severe form is beta thalassemia major requiring lifelong blood transfusions and iron chelation therapy. Complications include anemia, jaundice, bone changes, iron overload affecting organs, and growth issues.
Principles of Radiation Therapy (July 2021)OBGYN Notes
This document provides an overview of principles of radiation therapy. It defines key terminology like radiation oncology, dosimetry, and radiation physicists. It describes different types of radiation including photons, electrons, and other particles. It explains how radiation is delivered through linear accelerators and other systems. It also covers topics like dose calculations, fractionation schedules, and the goals of delivering precise radiation doses to tumor volumes while sparing surrounding healthy tissues.
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- Unstable lie refers to a frequently changing fetal position in late pregnancy, usually after 37 weeks. It can be diagnosed through abdominal palpation.
- The risk factors include fetal macrosomia, anomalies, and maternal factors like high parity, uterine abnormalities, and pelvic issues.
- Management includes observation with the expectation of spontaneous version in many cases. Physical techniques and ultrasound can also be used.
- Options are expectant monitoring, attempting external cephalic version in a medical facility, or elective c-section depending on the situation and ability to safely attempt vaginal delivery. Close monitoring is important with an unstable lie.
Red cell alloimmunization, also known as Rh disease, occurs when a woman develops antibodies against the Rh factor in her baby's blood. This can cause hemolytic disease of the fetus and newborn if she has a subsequent Rh-positive pregnancy. Screening involves testing the mother's blood type and performing an antibody screen and Kleihauer-Betke test if needed. Diagnosis may involve ultrasound to check the fetus for signs of anemia like increased blood flow in the middle cerebral artery. Treatment depends on the severity and includes monitoring the pregnancy, intrauterine fetal transfusions if indicated, or early delivery. Noninvasive prenatal testing using cell-free fetal DNA in the mother's blood can also determine the baby's
* These are Dr Gebresilassie's Amazing Notes.
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Obstetric analgesia and anesthesia 2021OBGYN Notes
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Fetal echocardiography should be performed to evaluate for any structural heart defects, as supraventricular arrhythmias can sometimes be associated with congenital heart disease. Conservative management with close monitoring would be reasonable if the echocardiogram is normal. C-section and amiodarone are not indicated based on the information provided.
This is a clinically oriented maternal anatomy, prepared by Dr Gebresilassie Andualem
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Contents
Introduction to Operative Deliveries
Vacuum-AssistedVaginal Delivery
Forceps-AssistedVaginal Delivery
Sequential Use of Instruments
Destructive Delivery
2
3. Introduction to Operative Deliveries
• refers to a delivery in which the operator uses
– Devices to assist mother in transitioning fetus → to Extrauterine life
• Operative delivery can be divided into
A. operative vaginal delivery and
B. cesarean delivery
• success and safety of OD depends upon
– operator skill
– proper timing
– proper indications
3
are met while contraindications are avoided
4. • In Ethiopia : ➔ Ethiop.J.Health Dev.2004;18(2)
– Forceps deliveries = 14.8%
– Vacuum deliveries = 18.7%
• UTD 2021- @
Forceps deliveries - 0.5 percent of vaginal births
Vacuum deliveries - 2.6 percent of vaginal births.
• Overall rate of OVD diminishing
– vacuum → increasing while forceps → declining}
– 4 reasons for decline in the use of forceps >> vacuum
1. Medicolegal implications and fear of litigation
2. Reliance on CS as a remedy for abnormal labor and suspected fetal jeopardy
3. Perception that vacuum is easier to use and less risky to fetus and mother, and
4. Decreased number of residency programs that actively train residents in the use of
forceps
4
5. ABCs of operative vaginal deliveries
• A → adequate anesthesia
• B → bladder must be emptied
• C + D → cervix must be completely dilated
• E → fetal head must be engaged
• F → fontanels and direction of the occiput
(position) must be precisely known
• G → gush of amniotic fluid must occur
(membrane must be ruptured),
• H → hip size (pelvimetry) must be adequate
• I → correct indication must be present
• H → Halt traction when the contraction
is over; halt the procedure if it is not
progressing normally
Recommendations OVD
• classification is the same
• Same indications and
contraindications
• Operator - should be experienced
• Operator - should be willing to
abandon
CI for any OVD (Forceps/Vacuum)
Suspected CPD
Known fetal demineralization
diseases (eg, osteogenesis
imperfecta)
maternal Ehlers-Danlos syndrome
fetal bleeding diatheses (eg,
thrombocytopenia or hemophilia
Suspected macrosomia - not
contraindicated (ACOG)
– ≥ 4000 grams: ↑ed risk of
Fetomaternal injury
5
6. • Antibiotic prophylaxis is not necessary
– no benefit has been established, although data are sparse
• Factors determining choice of instrument
– clinician's expertise with the various forceps and vacuum devices
– availability of the instrument
– level of maternal anesthesia
– knowledge of the risks and benefits associated with each instrument in various
clinical settings
– Vacuum delivery
• less traumatic for the mother than forceps delivery
• easier to apply and require less maternal anesthesia than forceps
– Forceps
• significantly higher success rate
• can be used on premature fetuses or to actively rotate the fetal head
• do not aggravate bleeding from scalp lacerations
6
7. Vacuum delivery: compared to forceps Forceps: compared to vacuum
1. safer for mother: higher rates of fetal
morbidity
2. More likely to detach from the head ➔
Higher failure rate than forceps
3. Easier to learn
4. Less maternal discomfort during & after
delivery
5. should not be applied to fetuses < 34
weeks
6. biparietal diameter isn’t increased
7. easier to apply, place less force on fetal
head
8. Less need for maternal anesthesia
9. Less maternal blood loss
1. safer for the fetus ➔ higher rates of maternal injury
2. unlikely to detach from the head ➔ unlikely to fail to
achieve vaginal birth than vacuum
3. Greater duration of training needed
4. Greater maternal discomfort postpartum
5. Pre-term use less controversial
6. biparietal diameter is increased by the thickness of each
forceps blade
7. may be used for a rotation
8. cause significantly more acute maternal injury and fetal
facial nerve injury than vacuum ??????
9. Easier to apply with caput
10. Used with breech presentation
11. Less difficult to apply to deflexed head
12. Less incidence of shoulder dystocia
❑ Failure rates : 12% ❑ Failure rate : 7%
7
8. 8
Type Description
High ▪ Not included in this classification
Midforceps
▪ head is engaged (ie, at least 0 station), but the leading point of the skull is not ≥2 cm beyond the
ischial spines (ie, station is 0 to +1/5 cm)
Low Forceps
▪ Leading point of fetal skull is at ≥ 2 cm beyond the ischial spines and not on the pelvic floor.
▪ station is at least +2/5 cm
▪ Rotation 45 degrees or less to LOA/ROA to OA or LOP/ ROP to OP, or rotation is 45 degrees
or more
▪ Low forceps have two subdivisions:
o Rotation ≤ 45 degrees
o Rotation > 45 degrees
Outlet
▪ Scalp is visible at the introitus without separating the labia.
▪ Fetal skull has reached the pelvic floor.
▪ Sagittal suture is in the AP diameter or LOA/ROA or LOP/ROP positions.
▪ Fetal head is at or on the perineum.
▪ Rotation does not exceed 45 degrees
Operative vaginal delivery classification
Classification of vacuum deliveries should be the same as that used for forceps deliveries (including station)
10. Vacuum-AssistedVaginal Delivery
• Vacuum delivery is effected using the ventouse (vacuum extractor)
• main action - traction ± rotation
• Theoretical advantages of the vacuum over forceps include:
– (1) avoidance of insertion of space-occupying steel blades within the vagina,
– (2) no requirement for precise positioning over the fetal head,
– (3) less maternal trauma, and
– (4) less intracranial pressure during traction
• Vacuum extraction accounts for over 80 percent of operative vaginal deliveries in the
United States (UTD 2021)
• three major categories of indication (NB: no absolute indication) – UTD 2021
– prolonged second stage of labor,
– nonreassuring fetal status, and
– shortening the second stage for maternal benefit
10
11. Contraindications forVacuum extraction
• no quality data for firm recommendations regarding
– GA & limit below which vacuum extractor should not be used
• most experts limit the procedure to GA > 34 {cut-off} weeks
– This is b/c premature head is likely at greater risk for compression-decompression
injuries simply due to
• pliability of preterm skull and
• more fragile soft tissues of the scalp
• Vacuum should not be applied to fetuses < 34 weeks of gestation
• Experts have recommended avoiding use of vacuum devices to assist delivery
before 34 weeks of gestation due to a perceived increased risk of birth injuries
(Intracranial hemorrhage) in preterm infants (UTD 2021)
• Relative contraindications
– Prior scalp sampling or multiple attempts at fetal scalp electrode placement
– because scalp trauma from these procedures theoretically may increase the risk of
cephalohematoma or external bleeding from the scalp wound
11
12. Mnemonic for vacuum extraction
12
A
o Ask for help; address the patient (inform her about what you are going
to do and get informed consent); assess anesthesia needs
B o Bladder empty
C o Cervix fully dilated
D o Determine fetal position and think shoulder dystocia
E o Extractor and resuscitation equipment ready
F o Apply cup on the flexion point
G o Gentle traction in the proper axis
H
o Halt traction when the contraction is over; halt the procedure if it is not
progressing normally
13. • Prerequisites
– Vertex presentation with fetal
position identified
– Fully dilated cervix43
– Engaged head: station at 0 or not
more than 2/5 above symphysis
pupis44
– Ruptured membranes
– Live fetus; Term fetus
• Preparation
– Empty bladder
– Local anesthesia infiltration for
episiotomy
– Assembled and tested vacuum
extractor
• Indications
– 1. Prolonged second stage of labor
– 2. To shorten second stage in:
• Maternal distress
• Preeclampsia/ eclampsia
• Cardiac or pulmonary diseases
• Glaucoma,
• Cerebrovascular disease: CNS
aneurisms etc.
– 3. Fetal distress and cord prolapse
• Contraindications:
– CPD, Fetal coagulopathy
– Non-vertex presentation such face ,
breech (after-coming head)
13
14. Components ofVacuum Extractor
• Main components
– Vacuum force (Pump) - Electrical, hand
pump or pedal pump
– Suction cup
• is connected to a handle grip: Metallic or
Plastic
• Differ in shape and size
– Vacuum pump
– Traction devices
– Suction tube: connects cup both to a
vacuum source
– Traction chain
– Pressure gauges
14
15. Decision to use ➔ soft cups Vs metal cup
Cups Soft cups Metal cup
Main d/ce Easy to apply
lower incidence of scalp injury
more commonly in the United States
negative pressure can be increased to 0.8
kg/cm2 over as little as 1 minute
vacuum can be developed quickly and
therefore can be released between
contractions, which decreases injury to the
fetal scalp due to abrasions
Fewer superficial scalp injuries
higher rates of adverse outcomes
more suitable for occiput posterior, transverse, and
difficult occiput anterior deliveries
vacuum be created gradually by increasing the
suction by 0.2 kg/cm2 every 2 minutes until a
negative pressure of 0.8 kg/cm2 is reached
Can be autoclaved
More difficult to apply & More uncomfortable
Higher incidence of fetal scalp injuries
Failure 16% 9%
Detachment 22% 10%
However, high-pressure vacuum generates large amounts of force regardless of the cup used
15
• Soft cups are usually bell shaped, while rigid cups tend to be mushroom shaped
• Bell-shaped cups - draw chignon into the cup, thereby reducing the available vacuum
area and leading to a decrease in cup adhesiveness at the edges.This allows leakage of
air and eventual detachments
• M-style cups - tends to draw chignon into the cup while edges interlock with the base
of the chignon, thereby creating a mechanical attachment that seems to
compensate for the loss of available vacuum space
16. Choice of vacuum cup
• A soft vacuum cup is appropriate for most deliveries
• Rigid cups may be preferable for
– occiput posterior,
– occiput transverse, and
– difficult occiput anterior deliveries because they are less likely to
detach
16
17. • 1st vacuum system – assembled & ensure that no leaks are present
• Cup placement
– directly over the sagittal suture at the median flexion point
• to provide the smallest diameter to the maternal pelvis
• Mento vertical diameter
– Proper cup placement - the most important determinant of
success
– Anterior placement ➔ result extension
– Asymmetrical placement relative to sagittal suture →
worsen asynclitism
• Incorrect placement on an asynclitic head results in
– unequal distribution of force and
– Increased risk of neonatal intracranial injury and scalp
lacerations
OA: approximately 6 cm from the anterior fontanelle and 3 cm
from the posterior fontanelle
OP: positioned more posteriorly and higher in the vagina
17
18. 4 Possible positions of cup
Flexing median {Ideal} Paramedian application Deflexing median Deflexing paramedian
☻cup is properly placed
over the flexion point
☻cup is placed to either
side of the midline, but
not too far forward
☻cup is placed both too
far forward but is in the
midline
☻cup is placed both too
far forward and off to
either side
☻No problem ☻worsen asynclitism ☻result extension ☻Extension + asynclitism
18
19. • suction creates artificial caput succedaneum ( “chignon”)
– This allows for appropriate traction force to be applied to the vertex without a
“pop off” or detachment
• As with forceps application ➔ the following checks : prior to traction
No maternal tissue : under the cup margin
• Entrapment of maternal soft tissue
– Mother: lacerations and hemorrhage
– Cup "pop-off"
• Presence or absence of fluid trap does not affect effectiveness of vacuum
Cup should be placed → @ median flexion point
19
20. • During contraction → along the pelvic axis
– along the axis of the pelvic curve (ie, down then up)
• Intermittent : If > 1 contraction is necessary
– vacuum pressure can be decreased to low levels between contractions
• descent of fetal head should occur with each pull, ➔ 3Ds
1st pull → flexion of head & descent → Dislodge
2nd pull → head should be on pelvic floor → Descent
3rd pull → Deliver
• Maximum
– number of cup detachments : limited to two or three
– duration of vacuum application prior to abandonment of the procedure: 20 to 30
minutes
• If No progress or ≥ 2 "pop-offs" ➔ CPD should be suspected → cesarean delivery
20
21. • Recommended pressures:
– Vacuum suction pressures of 500 to 600 mmHg have been recommended, although pressures in excess of 450
mmHg are rarely necessary
• NB: 0.8 kg/cm2 of atmospheric pressure = 600 mmHg = 23.6 inches of Hg = 11.6 lb/in2 (pounds per square inch)
– Create a vacuum of 0.2 kg/cm2 (approximately 200 mmHg) negative pressure and check that maternal tissue
(cervix or vagina) is not entrapped
– Gradually increase the vacuum to 0.8 kg/cm2 (approximately 600 mmHg), and recheck the application and that
maternal tissue is not entrapped
– Induce a vacuum pressure of 20 kpa (0.2 kg/cm2) and recheck the cup position.
– Then increase the vacuum in one step to the recommended pressure of 80 kpa (0.8 kg/cm2)
• Delay traction for 2 minutes to allow chignon to form
– 0.2 kg / 2 min = rigid cap
– 0.8 kg / 1 min = soft cap
– Slow, stepwise application of suction does not improve safety or efficacy
ContinualVersus Intermittent Vacuum Pressure
• Pressure can be maintained or released between contractions with no change in outcome
• Traction should be discontinued between contractions
21
22. • Detachment of the suction cup from fetal head
• Associated with increased fetal head trauma
• Caused by:
Maternal tissue or scalp electrode caught
under edge of cup
Incorrect technique (pulling too hard, in
wrong direction, or without a
contraction)
Large caput succedaneum
Deflexing or paramedian application
Bending or twisting the cup, handle, or
shaft
Rotating the cup
Inadequate pressure or faulty equipment
• So re-evaluate the site of application,
direction of axis traction, and fetal maternal
pelvic dimensions.
Duration
• The maximum time to safely complete a
vacuum assisted delivery and the number of
acceptable "pop-offs" are unknown
• Ff are commonly recommended.. a maximum
of
– two to three cup detachments
– three sets of pulls for the descent phase
– three sets of pulls for the outlet
extraction phase, and/or
– a maximum total vacuum application time
of 15 to 30 minutes
22
23. FailedVacuum
• Diagnosis is based on any one of the following conditions
– The head does not advance with each pull;
– The fetus is not delivered with 3 pulls;
– The fetus is not delivered within 30 minutes;
– The cup that is applied appropriately and pulled in the proper direction with
maximum negative pressures slips off the head twice
• After failed vacuum, the fetus is delivered by Cesarean section. Every
vacuum application should be considered as a trial of vacuum delivery
• Some reasons for failure include:
– Fetopelvic disproportion
– Incorrect technique
– Paramedian or deflexing applications
– Large caput succedaneum
23
24. Complications
• Fetal
– Localized scalp oedema (caput succedaneum or chignon) under the vacuum
cup is harmless and disappears in few hours.
– Laceration of scalp: provide local wound care as appropriate;
– Cephalhematoma requires observation: usually clears within 3-4 weeks
– Subaponeurotic hemorrhage
– Intracranial hemorrhage: very rare but requires immediate intensive care
– Necrosis is extremely rare.
• Maternal
– Tears of the vagina or cervix are repaired as appropriate
24
25. • With vacuum extraction, a metal cup compared with a soft cup is associated with significantly
higher rates of which of the following?
– A. Cephalohematoma B. Birth canal trauma
– C. Low Apgar scores D. None of the above
• In general, vacuum extraction would be contraindicated in all EXCEPT which of the following
clinical settings?
– A. 30-week fetus
– B. Fetal thrombocytopenia
– C. Occiput transverse presentation
– D. Inability to assess fetal head position
• With vacuum extraction, correct cup placement is described by which of the following?
– A. Centered across the sagittal suture
– B. Placed over the posterior fontanel
– C. If ROA, the cup is placed on left fetal parietal bone.
– D. Traction axis is aligned with the suboccipitobregmatic diameter
25
26. Forceps-AssistedVaginal Delivery
26
A Triple Obstetric Tragedy
• Death of mother, her son & the midwife
• November 6, 1817
– Princess Charlotte’s labor
• managed by Sir Richard Croft
• SSOL = lasted 24 hour, including 6 hours on the perineum
• Then ➔ Princess delivered a 9 lb (4 kg) stillborn male heir
– within 24 hours of delivery, the Princess herself died of a
massive postpartum hemorrhage
– Disturbed with depression and despair at the blame for the death
of both the Princess and the heir to the British throne, Croft
shot himself 3 months later
– Forceps was not applied for fear of infection (there
was no antiseptics)
• This triple tragedy allows more liberal use of
forceps & earlier intervention
27. • Indications
– Prolonged second stage
– To shorten the second stage in cases with
• Maternal distress
• Preeclampsia, eclampsia
• Cardiac or pulmonary diseases
• Glaucoma,
• Cerebrovascular diseases: aneurysm, CVA etc
– Fetal distress and cord prolapse
– After-coming head in breach presentation
• Prerequisites
– Presentation & position
Vertex presentation with occipitoanterior or
occiput posterior
Face presentation with mentoanterior
After-coming head in breech (Piper’s forceps)
Engaged head with a station of +2 or below
Fully dilated cervix
Ruptured membranes
No contraindication to vaginal delivery such
as CPD
• The two acceptable forceps operations
with minimum trauma to the mother and
fetus are:
– Low forceps: application when the leading
part of the fetal scalp is at station +2 or
below but not on the pelvic floor.
– Outlet forceps: application when the head
is at perineum and visible at introitus
between contractions.The fetal scalp has
reached the pelvic floor
27
28. Anatomy of Forceps
• two crossing branches
• Each - four components:
❑ Handle → Lock → Shank → Blade
• has two curves
1. Cephalic curve
• conforms to the shape of fetal head & even distribution
of force
2. Pelvic curve
• Ease of application - pelvic axis
• Heel: the back of the blade
• May be
– solid (Tucker-McLane)
– Fenestrated (Simpson) or
– pseudo fenestrated (Luikart-Simpson)
28
Handles transmit the applied force
Lock : fulcrum
Blades transmit the load
29. Pelvic & cephalic curve, shank, blade, lock, and handle
• are different for each type of forceps
• These features determine the type of forceps - best suited for appropriate indication
– Simpson or Elliot forceps
• most often used for vaginal deliveries
• Simpson forceps are suited for application to fetal head
– Molded head: common in nulliparous women
– Kielland or Tucker-McLane forceps
• used for rotational deliveries
• Kielland forceps – better ??? {see above}
– Tucker-McLane forceps have
• shorter, solid blade and
• overlapping shanks
» more often used for rotations than other classic instruments.
– Piper forceps
• for delivery of the aftercoming head : breech deliveries
• b/c → have a reverse pelvic curve compared to other forceps
❑ NB: Elliott or Tucker-McLane type forceps are better suited to a round unmolded head ➔ Because these
instruments have a more rounded cephalic curve
– rounded head: more characteristically seen in multiparas
29
30. Forceps Classification - according to their intended use
1. Classic 2. Rotational 3. Specialized
Purpose:Traction Kielland {frequently used },Tucker-McLane Piper forceps
English lock sliding lock English lock
Typically used when rotation of
vertex is not required for delivery
→However, they may be used for
rotations such as the Scanzoni-
Smellie maneuver { rotation
from OP to OA}
type is determined by its shank
1. parallel: Simpson, DeLee,
Irving, and Hawks Dennen
2. overlapping: Elliott and Tucker-
McLane
cephalic curve - amenable to application to molded vertex
pelvic curve: Reverse {either only a slight curve or none at all
overlapping shanks
Why Kielland – best for rotation ???
1. straight design : places handle & shanks in the same plane as
the long axis of the fetal head ➔ allow toe to travel through a very
small arch during rotation
2. Long distance between the heel and intersecting point of shanks
➔ accommodates heads of various shapes and sizes associated with
unusual molding.
3. Reverse pelvic curve ➔ facilitates rotation of vertex without
moving handles through a wide arch
4. Sliding lock: permits placement of the handles at any level on the
shank to accommodate the asynclitic head and subsequent
correction of asynclitism
aftercoming head
{Assisted BVD}
reverse pelvic curve
long parallel shanks :
permit body of the
breech to rest against it
during delivery of head
30
32. Novel devices
Thierry orTeissier spatula
• consist of two independent and symmetric branches which
include a shank, handle, and wide solid blade
• The shanks do not articulate; thus, each branch acts as an
independent lever and the head is not compressed between
the blades
• Outcome data are limited and primarily published in French,
but neonatal complication rates appear to be similar to, or
slightly lower than, rates with other instruments
• In one large study, the rate of severe perineal injuries was
equivalent to that reported with other extraction instruments,
but vaginal tears were more common
32
33. Odon device
• developed by the World Health Organization for
use in areas that have limited or no access to
cesarean birth
• It is a low-cost device made of film-like
polyethylene material that creates a sac filled with
air that surrounds the entire head and enables
extraction when traction is applied
• It has the potential to be safer and easier to apply
than forceps or a vacuum extractor
• No randomized trials have published data
regarding its safety and efficacy.
• In a pilot observational study, the Odon Device
alone assisted in the birth of 19 of the 40
newborns, with no serious maternal or neonatal
adverse outcomes related to its use
33
34. • Before the application of forceps, determine
– Position, station
– adequacy of pelvic diameters of midpelvis and outlet
• 1st left Blade ➔ Right blade
– When blades are inserted in this order: right shank comes to lie
atop the left
• If there is any resistance to blade entry into maternal pelvis
– blade should be removed and
– application technique re-evaluated
• 3 – Applications
– Bimalar-Biparietal: Optimal
– Fronto- Mastoid: Suboptimal
– Fronto-Occipital:
• blades should have a bimalar, biparietal placement when applied
properly
• After positioning, the branches are articulated
34
35. • three landmarks in checking a proper forceps application:
1. Posterior fontanelle: should be
• one finger breath above the plane of shanks
• equidistant from the sides of the blades: midway between the blades
• directly in front of the articulated forceps
2. Sagittal suture
• perpendicular to the plane of the shanks
• blades - equidistant from sagittal suture
3. Fenestration : If fenestrated (open) blades are used
• should be barely palpable
• the amount of fenestration in front of the fetal head should admit no more than the tip of 1 finger
• Appropriately applied forceps grasp : OA fetal head such that :
☻long axis of blades corresponds to occipitomental diameter
☻tips of blades lie over the cheeks
☻No maternal tissue has been grasped.
❑ Once the forceps articulate, the above checks should be performed before any traction
35
36. • Pelvic shape →
• DirectionVs traction
– Initially :Horizontal
– vertically as fetal head extends {crowns }
► b/c head negotiates the final position of pelvic curve
by extension
• Traction should be steady (not rocking)
• applied during contractions
• should be intermittent
– head should be allowed to recede in intervals, as in
spontaneous labor
• Except when urgently indicated, as in severe fetal bradycardia,
– delivery should be sufficiently to
prevent undue head compression
• Amount of traction force
– Primiparas: 20 kg
– Multiparas: 13 kg
– no consensus
• Traction axis principle
– force is directed in two vectors
– Downward and Out
• One hand holds the shanks and exerts downward
traction while
• operator's other hand holds the handles and exerts
traction outward
• Episiotomy
– as vulva is distended by the occiput
• Disarticulation:
– as the head crowns in the reverse order of application
• first right blade ➔ left blade
– To reduce the risk of laceration
• before widest diameter of fetal head passes through
the introitus
– Modified Ritgen maneuver
• Upward pressure from coccygeal region to extend the
head during actual delivery, thereby protecting the
musculature of the perineum
36
37. 37
Method of axis traction
• Pajot-Saxtorph maneuver: left hand grips the shanks and exerts a downward pull.The right hand
grips the handles and exerts a pull parallel to the floor
38. Choice of forceps
• Size and shape of fetal head and maternal pelvis - should match the size, cephalic curve, and pelvic
curve of the forceps
– Simpson type forceps - best fit for a molded head because of the less concave cephalic curve.
– Elliott type forceps orTucker-McLane type forceps - better suited to a round, unmolded head as the
cephalic curve of the forceps is more concave.
– Fenestrated blades allow for a better grip and therefore are less likely to slip, but the fenestrations increase
the risk for tissue laceration when greater forces are applied
• Solid blades are less likely to lacerate the fetal head but may be more likely to slip with increased traction
• Pseudo fenestrated blades have a shallow indentation rather than a true fenestrated, which may reduce slippage while also
reducing risks of laceration.
• Direction of traction and type of rotation
– Kielland forceps - useful for rotations because of their minimal pelvic curve and sliding lock
• A sliding lock is helpful when there is asynclitism.
– Piper forceps are used to deliver the aftercoming head in vaginal breech deliveries
• Station
– Midpelvic deliveries - Bill's axis traction handle or Irving forceps
• Operator experience and preference
38
39. • Introduced by Dee Lee (1920)
• refers to outlet forceps delivery, only to
– shorten the second stage of labour for prevention of anticipated maternal or fetal complications in
• Eclampsia, Heart disease, Previous CS
• Post maturity, During epidural anaesthesia
• Low birth wt babies
– no significant differences in outcomes in neonates who weighed 500 to 1500 g and who were delivered
spontaneously or by outlet forceps
• no consensus impact of prophylactic low forceps delivery {in low birth weight infants}
– Some ➔ increased risk of intraventricular hemorrhage with prophylactic low forceps
– Others ➔ no differences in neonatal outcome between infants delivered by low forceps and spontaneously
– maternal body mass index > 30
– estimated fetal weight > 4000 g or clinically big baby
– occipito-posterior position
– mid-cavity delivery or when 1/5 head palpable per abdomen
39
40. Failed Forceps
• A failed forceps is diagnosed if:
– Fetal head does not descend with each pull,
– Fetus is undelivered after three pulls with no descent or after 30 minutes
• The possible causes are:
– Undiagnosed CPD
– Incomplete cervical dilatation
– Wrong diagnosis of position
– Incorrect application
– Cervical entrapment
• When application of forceps or traction does not yield, reassess for possible cause.After a
failed forceps, Cesarean delivery is undertaken if the fetus is alive
• If an attempt at operative vaginal delivery is anticipated to be difficult, the attempt should be
considered a trial
40
41. Maternal Vs Neonatal Risks
• Maternal and fetal complication rates depend on ff factors
Parity
Forceps: type
Vacuum: cup position & type
position & station at application
Posterior presentation
Increased birth weight
Rotation of > 450
1. Asphyxia
2. Trauma
– Intracranial haemorrhage
– Cephalic haematoma
– Facial / Brachial palsy
– Injury to the soft tissues of face & forehead
– Skull fracture
3. Remote-cerebral palsy.
– Fetal death - around 2% ???
1. Injury
– Extension of the episiotomy involving anus &
rectum or vaginal vault.
– Vaginal lacerations and cervical tear if cervix was
not fully dilated.
2. PPH trauma,Atonic uterus or Anaesthetisia
3. Shock blood loss, dehydration or prolonged labour
4. Sepsis
– Due to improper asepsis or devitalisation of local
tissues
5. Anaesthetic hazards.
6. Delayed or long-term sequel
– Chronic low backache, genital prolapse & stress
incontinence.
41
42. • A 41-year-old G1P0 at 39 weeks, who has been completely dilated and pushing for 3 h, has an
epidural in place and remains undelivered. She is exhausted and crying and tells you that she can no
longer push. Her temperature is 101°F.The fetal heart rate is in the 190s with decreased variability.
The patient’s membranes have been ruptured for over 24 h, and she has been receiving intravenous
ampicillin for a history of colonization with group B strep bacteria.The patient’s cervix is completely
dilated and effaced and the fetal head is in the direct OA position and is visible at the introitus
between pushes. Extensive caput is noted, but the fetal bones are at the +3 station.
– What is the most appropriate next step in the management of this patient?
• a. Deliver the patient by CS b. Encourage the patient to continue to push after a short rest
• c.Attempt operative delivery with forceps d. Rebolus the patient’s epidural
• e. Cut a fourth-degree episiotomy
– Compared to the use of the vacuum extractor, forceps are associated with an increased risk of which of the
following neonatal complications?
• a. Cephalohematoma b. Retinal hemorrhage c. Jaundice
• d. Intracranial hemorrhage e. Corneal abrasions
– What kind of forceps would be most appropriate to use in this delivery?
• a. Kielland b. Piper c. Simpson
– During the delivery, it is necessary to cut an episiotomy.The tear extends through the sphincter of the
rectum, but the rectal mucosa is intact. How would you classify this type of episiotomy?
• a. First-degree b. Second-degree c.Third-degree d. Fourth-degree
42
43. • In current obstetrics, forceps
deliveries are categorized into one of
the following three groups?
– Midforceps, low forceps, outlet forceps
• Describe a forceps applied to the fetal
head at +1 station?
– Midforceps
• Advantages to elective forceps
delivery include which of the
following?
– A. Lower rates of fetal acidosis
– B. Prevention of perineal laceration
– C. Lower rates of postpartum urinary
retention
– D. None of the above
• High forceps delivery – has No role in
modern obstetrics
43
44. • During forceps delivery of a fetus with a face
presentation, blades should be swept upward when
which of the following passes beneath the
symphysis?
– A. Chin B. Brow
– C. Upper lip D. Base of the nose
• During operative delivery of a fetus from a +2
station and ROA position, movements of the
forceps should follow which sequence?
– Rotation, outward traction, upward traction
• Fetal indications for forceps delivery include
which of the following?
– A. Fetal coagulopathy
– B. Fetal congenital heart block
– C. Nonreassuring fetal heart rate pattern
– D. Protection of fragile preterm infant head
• Factors associated with a failed trial of forceps and
need for cesarean delivery include which of the
following?
– A. Advanced parity
– B. Coexistent chorioamnionitis
– C. Poor maternal pushing efforts
– D. Absence of regional or general anesthesia
• For the fetus, forceps delivery, compared with
spontaneous vaginal delivery, is associated with
higher rates of all EXCEPT which of the
following complications?
– A. Facial palsy
– B. Impaired intelligence
– C. Brachial plexus injury
– D. Intracranial hemorrhage
• When correctly applied to a fetus in an occiput
anterior position, forceps align along which fetal
head diameter?
– A. Bitemporal B. Occipitofrontal
– C. Occipitomental
– D. Suboccipitobregmatic
• When correctly applied to a fetus with a face
presentation, forceps align along which fetal head
diameter? Occipitomental
44
45. Sequential Use of Instruments
• should not be performed routinely
• For a procedure to be considered sequential, traction is applied sequentially by two different instruments
– Situations in which an instrument is placed, but no traction applied, should not be considered a sequential attempt
– for instance, when proper placement of forceps cannot be achieved, or a vacuum device fails to achieve suction
and no traction has been applied
• sequential use of vacuum extraction and forceps
– increases the likelihood of adverse maternal and neonatal outcomes
• more than the sum of the relative risks of each instrument
• ACOG {2000} : cautions that these
• trials are attempted only if the clinical assessment is highly suggestive of a successful outcome
– balance the risks of a caesarean section with the risks of sequential use of Instruments
– Caesarean section in the second stage of labor is associated with an increased risk of
• major obstetric hemorrhage
• prolonged hospital stay and
45
46. Destructive Delivery
• Reductive surgical procedure performed on
the dead fetus to reduce its size and make
vaginal delivery possible
• Main advantages:
– Need few instruments
– prevention of
Cesarean delivery: Leaves the mother
with intact uterus
Dissemination of infection associated with
obstructed labor
• If she is already infected, low risk
of spread of infection to the
peritoneum
Maternal trauma
• Craniotomy
• Craniocentesis
• Evisceration
• Decapitation
• Cleidotomy
46
47. Indications of DVD
• CPD, Breach delivery
• Transverse lie
Prerequisites for DVD
• Dead fetus
• Fully dilated cervix
• No gross pelvic contracture
• No risk of uterine rupture
• 2/5 or less of his head must be
above the brim
• Back up operative facilities
Preparations of pts for DVD
• hydrate - crystalloid
• Hb, B/G & Rh {??}, cross
matched blood
• Broad spectrum antibiotics
• Catheterize
• Consent of patient/ parent
• Aseptic & antiseptic care
• Anesthesia as per individual need
• Alert the OR staff
• Lithotomy position
47
50. Craniotomy
• head - perforated to evacuate the brain tissue
Indication
• Obstructed labor with a vertex or face
• Arrested after coming head
• Interlocked head of twins
• Contracted pelvis is the most common indication
Contraindication
• Severely contracted pelvis with
– true conjugate < 7.5 cm
– won’t allow the delivery of the uncompressible bimastoid
which has 7.5 cm diameter
• Ruptured uterus (Laparotomy needed)
• Dead fetus without obstruction ????
• Doubtful fetal demise
– Benefit of doubt goes to mother & fetus
• Ruptured membranes
• Instruments:
– Oldham’s perforator
– Budin’s cannula
– Big Mayo’s scissor
50
Presentation & Site of Entry
Presentation Site of Entry: perforator or scissors
Vertex ☻Parietal bones either side of sagittal Suture
Face ☻Orbit/hard palate
Brow ☻Frontal bones
After coming
head
☻Foramen magnum
51. ScalpTraction
• Introduce the perforator, with closed blade, under palmar aspect of fingers
protecting anterior vaginal wall and bladder at predetermined site.Avoid sudden
sliding of your instrument over the skull and getting into maternal tissue.
• Open the perforator or the scissors and rotate it to disrupt the brain tissue; the
brain tissue should now be coming out from the hole.
• Put 3-4 strong vulsellum forceps, kochers or heavy-toothed forceps on the skin
and bones and pull on the forceps to achieve vaginal delivery.
• Protect the vagina by avoiding sharp scalp bone edges tearing the vaginal wall by
your finger or by removing the offending bones.
• As the head descends, pressure from the bony pelvis will cause the skull to
collapse, decreasing the cranial diameter
51
52. Craniocentesis
• to deliver the hydrocephalic head through
– Vaginal or Uterine incision at time of cesarean section
INDICATION
• Cephalic or after coming breech presentation with hydrocephalic dead fetus
• A Live fetus with congenital malformation incompatible with life and severe
hydrocephalus (HC>40cm)
52
Cephalic presentation with After-coming head
Dilated cervix Closed cervix
large-bore spinal needle →
Sagittal suture line or
fontanel
Palpate - location of
fetal head
Needle through the
abdomen and uterine wall
{suprapubic area} →
hydrocephalus head ➔
Drain CSF
Two ways of CSF draining:
needle →
1. Foramen magnum
2. Spinal canal (spondylectomy)
If fetus has spina bifida
❑Drain by reaching cranium
through the defect and spinal cord
Drain CSF until skull has collapsed and allow normal delivery to proceed
• Pass a large-bore spinal needle through
the dilated cervix and through the
sagittal suture line or fontanel of the
fetal skull
• Drain / aspirate the CSF until the skull
has collapsed and allow normal delivery
to proceed.
53. Evisceration
• is removal of thoracic and or abdominal
contents through an opening at most
accessible site on the abdomen or thorax
• Indications
– Neglected shoulder presentation with
dead fetus & neck not accessible for
decapitation
– Fetal malformation (fetal ascites,
monsters, distended bladder &
hydronephrosis)
• Instruments: Embryotomy Scissor
53
54. Decapitation
• is severing the fetal head ➔
– Trunk and decapitated head → delivered separately
• Indication
– obstructed labor in shoulder presentation when
the neck is easily accessible
– locked twins
• Instruments
– Decapitation hook with Jardin’s knife
– Embryotomy scissor
– Hook with crochet : to pull
– GiantVulsellum
• in transverse lie
– neck of the fetus has to be accessible for
decapitation: If the neck
• can be reached ➔ attempt decapitation
• is difficult to reach but the body is well down➔
attempt evisceration
• & body are both still high in the birth canal ➔
cesarean section
54
55. Cleidotomy
• Cleidotomy is used to reduce the bulk of the shoulder girdle of
the dead fetus by cutting one or both clavicle(s)
• It is indicated in shoulder dystocia
55
56. Post-destructive operation care
• Explore the uterus, cervix and vagina and treat accordingly
• Repair episiotomy
• catheter for 7-14 days
• Treat infection: Broad spectrum antibiotics
– Cover G-ves + Anaerobes
• Correct anemia , dehydration and hypovolemia
• Suppress possible breast engorgement
• Help the woman morn loss of her fetus and counsel her on future pregnancy
Complications of destructive operations:-
• Post partum hemorrhage due to atonic uterus or genital trauma
• Shock due to hemorrhage or sepsis
• Trauma to birth canal
• Puerperal sepsis
• Injury to adjacent organs -VVF,UVF or RVF
56