This document discusses operative vaginal delivery techniques such as forceps and vacuum extraction. It begins with a brief history of forceps development and changing cesarean and operative vaginal delivery rates over time. The document then covers topics like types of forceps, indications and contraindications for operative vaginal delivery, prerequisites, techniques for forceps application, and maneuvers to aid delivery. Alternative devices to forceps like the Odon vacuum extractor are also mentioned. Key references on the topic are listed at the end.
The normal FHR range is between 120 and 160 beats per minute (bpm). The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. Prematurity, maternal anxiety and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate.
Learn what is "fetal attitude", "fetal lie", different types of fetal presentation (cephalic, breech, compound, shoulder), how to determine fetal position, and how to do Leopold's maneuvers
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
The normal FHR range is between 120 and 160 beats per minute (bpm). The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. Prematurity, maternal anxiety and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate.
Learn what is "fetal attitude", "fetal lie", different types of fetal presentation (cephalic, breech, compound, shoulder), how to determine fetal position, and how to do Leopold's maneuvers
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
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.
The BPP combines the NST with ultrasonography fetal assessment by assigning points to the following parameters: fetal breathing movements, fetal body movements, reflex/tone/flexion-extension movements, and AFV. Thus, this test assesses indicators of both acute hypoxia (NST, breathing, body movement, tone) and chronic hypoxia (AFV). The BPP score has a direct linear correlation with fetal pH.
Science, practice and evidence are dynamic processes. This is typically vivid when it relates to Polycystic Ovarian Syndrome. PCOS is the commonest hyperandrogenic disorder in women and one of the most common causes of ovulatory infertility. Although polycystic ovaries were first described by the Italian scientist Vallisneri in 1721, it was largely forgotten until the 1930s, and then renamed after its rediscoverers as Stein-Leventhal syndrome. Even then, it still wasn’t until the invention of the ultrasound scanner in the 1980s and consensus of diagnosis in the early 1990s that PCOS was recognized on a wider scale in women of reproductive age. When attempting to diagnose with precision something that is complex, it is important that we first clearly define what it is we are trying to diagnose. PCOS is today seen as a heterogeneous syndrome where a range of symptoms may be present or absent, and may overlap with other conditions, it is perhaps best viewed as a spectrum of symptoms, pathologic findings and laboratory abnormalities. PCOS can be difficult to conceptualize, even for experts, as shown by the fact that there have been several different ways of diagnosing it over the years.
More recently, the fundamental role of hyperandrogenism has been pointed out.
However, PCOS compromises other pathological conditions that strongly modify the phenotype and play a dominant role in the pathophysiology of the disorder, including insulin resistance and hyperinsulinemia, obesity and metabolic disorders, all favoring together with androgen excess, an increased susceptibility to develop type 2 diabetes mellitus (T2DM) and, possibly, cardiovascular diseases. PCOS by itself may also have some genetic component as documented by familial aggregation and recent genetic studies. All the clinical features may however change throughout the lifespan, starting from adolescence to postmenopausal age. Therefore, PCOS should be considered as a lifetime disorder.
I sincerely hope that with the recommended readings attached and lecture, you will be able to strengthen your knowledge, thereby providing evidence-based medicine practice for the management of PCOS in a successful manner to improve and better women’s Health care. The best investment you can make is an investment in yourself. The more you learn, the more you’ll earn (Warren Buffett), so read as much as you can.
Thank You.
Regards: Rafi Rozan
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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
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.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. INTRODUCTION
The era of modern operative obstetrics began
with the invention of the forceps by Peter
Chamberlen of England. Subsequently, over
the years the ability to use forceps separated
the obstetricians from the midwives. The use
of forceps reached its acme in the United
States as a result of the influence of DeLee,
who in 1920 taught the importance of
prophylactic forceps and episiotomy to protect
against maternal and fetal injury.
Dr.Rozan
4. In 1968 in New York City, 29.7% of births were forceps assisted,
but by 1978 the incidence was down to 12.2%.
At the same time, in the United States, cesarean birth rates rose from
5.5% in 1970 to 15.2% in 1978 and now is as high as 20–25%.
2015 – 3.1% OVD
0.56 Forceps
2.58% vacuum
Dr.Rozan
18. Classification & Criteria for Types of Forceps Deliveries
Low Forceps
Outlet Forceps
Mid Forceps
• Scalp is visible at the introitus without separating the labia
• Fetal skull has reached the pelvic floor
• Fetal head is at or on perineum
• Sagittal suture is in anteroposterior diameter or right or
left occiput anterior or posterior position
• Rotation does not exceed 45 degrees
• Leading point of the fetal skull is at station +2 cm or
more and not on the pelvic floor
• Without rotation: Rotation is 45 degrees or less (right or
left occiput anterior to occiput anterior, or right or left
occiput posterior to occiput posterior)
• With rotation: Rotation is greater than 45 degrees
• Station is above +2 cm but head is engaged
Dr.Rozan
19. Indications for Operative Vaginal Delivery
Nulliparous: 3 Hours
• Suspicion of immediate or potential fetal compromise
• Shortening of the second stage of labor for maternal benefit
• Prolonged second stage of labor
Multiparous: 2 Hours
Epidural Anesthesia: 1 extra hour with RFT
Acute Placental Abruption
ValSalva Maneuver is Contraindicated
Cardiac Abnormalities
Neurological Disorder
Muscular Disease
Cystic Lung Disease
Dr.Rozan
20. Contraindications
• Extreme fetal prematurity
• Fetal demineralizing disease (osteogenesis imperfect)
• Fetal bleeding diathesis ( fetal hemophilia, neonatal alloimmune
thrombocytopenia).
• Unengaged head
• Unknown fetal position.
• Brow or face presentation.
• Suspected fetal-pelvic disproportion.
Relative contraindications to use of vacuum devices, but not forceps,
include gestational age <34 weeks
Dr.Rozan
21. Prerequisites for Operative Vaginal Delivery
• Cervix fully dilated and retracted
• Membranes ruptured
• Engagement of the fetal head
• Position, Presentation, Station, Ortientation and any Asynclitism must be know
• Fetal weight estimation performed
• Adequate anesthesia
• Clinical Pelvimetry (Adequate pelvis to fetal size)
• Maternal bladder has been emptied
• Patient Consents to Procedure
• Willingness to abandon trial of operative vaginal delivery and back-up plan in
place in case of failure to deliver
• This is an operative procedure, and it should be accorded the same respect and
care for aseptic technique as any other operative procedure. Dr.Rozan
22. ANATOMY OF THE FORCEPS
Handle
Finger Guide
Lock
Shank
Blades
Cephalic Curve
Pelvic Curve
Heel
Toe
Fenestration
Window
Dr.Rozan
23. Some Types of Forceps
Simpson forceps (1848) are the most commonly used among the types of
forceps and has an elongated cephalic curve. These are used when there is
substantial molding of the fetal head.
Dr.Rozan
24. Elliot forceps (1860) are similar to Simpson forceps but with an
adjustable pin in the end of the handles which can be drawn out as a
means of regulating the lateral pressure on the handles when the
instrument is positioned for use. They are used most often when there
is minimal moulding.
Dr.Rozan
25. Kielland forceps (1915, Norwegian) are distinguished by an extremely
small pelvic curve and a sliding lock. The most common forceps used
for rotation. The sliding lock is helpful in asynclitic Kielland forceps lack
traction because they have almost no pelvic curve
Dr.Rozan
26. Wrigley's forceps are used in low or outlet delivery and in cesarean
section delivery where manual traction is proving difficult. The short
length results in a lower chance of uterine rupture.
Dr.Rozan
27. Piper's forceps have a perineal curve to allow application to the after-
coming head in breech delivery.
Dr.Rozan
29. ANATOMY OF THE FORCEPS
French lock English lock
German lock Sliding Lock
Pivot lock
Dr.Rozan
30. Technique of forceps application
The forceps must be applied so they fit
the head accurately. They should lie
evenly against the sides of the head,
reaching from the parietal bones to and
beyond the malar eminences covering
symmetrically the spaces between the
orbits and the ears.
Parietal – Malar
Ideal application
Dr.Rozan
31. -With the criteria for forceps application met, the forceps can be applied.
-The operator stands before the perineum with the forceps articulated and
oriented to the position of the fetus' head. Holding the forceps articulated
prevents confusion due to the crossing of the shanks.
-For the left occipitoanterior (LOA) or direct OA positions, the left blade
(posterior) is applied first.
-The operator places his or her back to the maternal right thigh and holds the
handle between the fingers, as in holding a pencil.
-The shank is held perpendicular to the floor, the middle and index fingers are
inserted into the vagina, and the thumb is applied to the heel of the blade.
- The force necessary to insert the blade is exerted by the pressure of the
thumb.
- The left hand guides the handle in a wide arc until the blade is in place. This
blade is then held in place by an assistant.
Technique of forceps application
Dr.Rozan
32. -The right blade is then inserted in a similar manner, with the
operator's back to the patient's left thigh.
-This blade is inserted more anteriorly in the vagina to avoid rotating
the head further to the left.
- Any adjustments to ensure a cephalic application should generally be
made with the right blade.
Technique of forceps application
Dr.Rozan
34. Once the blades are applied, the accuracy of placement should be evaluated.
Technique of forceps application
1. Lock articulation of the Forceps. Do not close the Handle
2. Ocipital Fontanel 1 finger beneath above the shank of the forceps
3. The shanks are perpendicular to the Sagital suture
4. One or less fingertip space at the heel of the blade
5. No maternal tissue has been grasped
Dr.Rozan
35. The Pull …
Technique of forceps application
Pajot Saxtorph Maneuver
Bill axis traction handle
Scanzoni Maneuver
OP
Dr.Rozan
Maternal Effort + Uterine Contraction + Devise Pull
36. Ritgen maneuver
Is used to control delivery of the fetal
head. It involves applying upward
pressure from the coccygeal region to
extend the head during actual delivery,
thereby protecting the musculature of
the perineum.
Modified Ritgen Maneuver
Dr.Rozan
46. 1. ACOG PB 154
2. Uptodate OVD
3. Williams Obstetrics 24 Ed
4. Martin JA, Hamilton BE, Osterman MJ, et al. Births: Final Data for 2015.
Natl Vital Stat Rep 2017; 66:1.
5. Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No.
154 Summary: Operative Vaginal Delivery. Obstet Gynecol 2015; 126:1118.
6. Palatnik A, Grobman WA, Hellendag MG, et al. Predictors of Failed
Operative Vaginal Delivery in a Contemporary Obstetric Cohort. Obstet
Gynecol 2016; 127:501.
7. American College of Obstetricians and Gynecologists, Society for Maternal-
Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the
primary cesarean delivery. Obstet Gynecol 2014; 123:693.
Referenc
es
Dr.Rozan
The history of obstetrical forceps is long and, often, colorful. Sanskrit writings from approximately 1500 BC contain evidence of single and paired instruments; Egyptian, Greek, Roman, and Persian writings and pictures refer to forceps that were originally used for extraction following fetal demise to save the mother’s life
DeLee's teaching was the impetus for the dramatic increase in the number of forceps deliveries performed in the United States from the 1930s through the 1950s.
DeLee's has many contribution to the era of modern obstetric.. Namely the fetal station.
However, due to the provocative studies by Friedman and colleagues and the increasing tendency for an adverse obstetric outcome to result in a malpractice suit, obstetric forceps delivery rates have fallen in the United States.
OVD remains an important part of modern obstetrics and its knowledge and application is vital in every labor setting so that we can decrease CS and save a life if the needs arise.
Knowing to do a Good Obstetric Explorartion is the Gold Key
AP diameter = 11.5 to 12cm
Oblique = 12.5 , Transverse = 13 cm, Inlet, mid, outlet and low
The Rhombus of Michaelis, also known as the Michaelis-Raute or the quadrilateral of Michaelis, it is a rhombus-shaped contour that is sometimes visible on the lower back.
The Rhombus of Michaelis is named after Gustav Adolf Michaelis, a 19th-century German obstetrician. 4 sides and angles
Baudelocque, martin or Budin Pelvimeters.
Bispinal = 24cm
Distance between iliac crest= 28cm
Distance between trocanters (Bitrocanter Diameter)= 32cm
The concept of fetal station was initially described by DeLee in 1924 as the level of the presenting fetal part in the birth canal in relation to the ischial spines.
Later, in 1988, ACOG first reported on a station classification system wherein the pelvis above and below the ischial spines is divided into fifths.
These divisions are represented in centimeters; if the leading part of the fetus descends at a level between the spines, the station is designated as 0.
Below the ischial spines, the presenting fetal part passes stations +1, +2, +3, +4, and +5 to delivery.
Fontanels and sutures allows for molding of the fetal hear as it passes through the birth canal.
In OVD it allows us to identify the Fetal Orientation thus being able to adequately and correctly place the Forceps.
The regions of the fetal skull have been designated to aid in the description of the presenting
Part felt at vaginal examination during labor.
The sagittal suture is parallel to the transverse diameter of the pelvis- symmetricly (Selhiem Law). 2 unequal ovoid will align on there greater diameter axis reasons why the fetal head orients sideways to the transverse diameter of the Pelvis
When the fetal head engages with some degree of tilt to the shoulder it results in asynclitism.
Anterior asynclitism, in which the anterior part presents, is called Nägele obliquity.
Posterior asynclitism, Litzman obliquity
Bitemporal asynclitism, Roederer obliquity
The American College of Obstetricians and Gynecologists' classification system for forceps deliveries is based on station and extent of rotation
To reduce the rate of CS for failure to progress in the second stage, ACOG & SMFM recommend allowing 3H of pushing for nulliparous women and 2H of pushing for multiparous women before diagnosing arrest of labor, when maternal and fetal conditions permit. They did not provide specific criteria for the upper limit of the 2nd stage. Many obstetric providers allow an extra hour of pushing for women with epidural anesthesia when there is reassuring fetal testing.
Use of forceps or vacuum is appropriate when expeditious delivery is indicated because of fetal compromise or probably imminent fetal compromise (eg, acute abruption)
Instrumental delivery is contraindicated if the clinician or patient believes that the risk to mother or fetus is unacceptable. Examples include, but are not limited to
Parietal Malar placement is important because It avoids over flexion or over extension of the fetal Head and as such preventing Maternal and fetal complications.
Applying the left blade first has the advantage of not needing to cross the shanks in order to lock the forceps
An alternative method of traction is to use a Bill axis traction handle and pull in the direction of the pointer.
In exerting traction, it is well to keep in mind the bell-shaped curve of a uterine contraction as seen on a fetal monitor. The traction force should gradually increase, reaching its acme at about 30–40 seconds and then gradually relaxing. For the resident being taught, it is instructive to actually count off the seconds out loud so that they can appreciate the time involved. Between tractions, the handles are unlocked to relieve pressure on the fetus' head.
Experts suggest 3 pulls are enough but its depends on the operator
The OVD should be abandoned if no success in 15-20 minutes. When the baby he is crowned then Restrictive Episiotmy is done if indicated and the blades are removed starting with the Right one.
Vacuum Assisted Delivery
Forceps Assisted Delivery
Argentinean Jorge Odón is a car mechanic by trade, and a tinkerer by nature. Recently,
Odón watched a video about an easy method for removing a cork stuck in a wine bottle.
And in the middle of the night it dawned on him that the same "trick" could be used during childbirth to help a baby that is stuck in the birth canal.
Odón's children were fortunately born without complications, but his aunt suffered nerve damage during childbirth, so Odón was familiar with the potential complications.
In an interview with the New York Times Odón explained that after seeing the wine bottle trick, it dawned on him that this could be used during childbirth.
Worldwide, more than 13 million births each year face serious complications, and every day about 800 women die from preventable causes related to pregnancy and childbirth (about 300,000 annually).
The use of forceps and other mechanical devices can aid significantly in the extraction of the fetus during second stage of labor.
With the help of his wife, he constructed a prototype using his daughter's baby doll, a glass jar and a fabric bag.
In time, and with several revisions of his design, Odón's idea — the Odón Device —
won the endorsement of the World Health Organization (WHO), big-time donors, and a medical technology company that wants to develop it for production.
Using the Odón Device, a lubricated plastic sleeve is slipped around the baby's head and inflated until it forms a grip.
Doctors then pull on the bag until the baby emerges. According to Dr. Margaret Chan, director general of WHO, the Odón Device
has the potential to save babies in poor countries, and reduce the number of emergency cesareans in rich ones.
"The Odón Device, developed by WHO and now undergoing clinical trials, offers a low-cost simplified way to deliver babies, and protect mothers, when labour is prolonged.
It promises to transfer life-saving capacity to rural health posts, which almost never have the facilities and staff to perform a C-section.
If approved, the Odón Device will be the first simple new tool for assisted delivery since forceps and vacuum extractors were introduced centuries ago," Chan said in a speech to the 65th World Health Assembly.