Placenta delivery during lscs
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This document discusses two common methods for delivering the placenta during cesarean section: controlled cord traction and manual removal. Controlled cord traction involves gently pulling on the umbilical cord after massage to facilitate delivery, while manual removal requires the obstetrician to insert their hand to separate the placenta. Some studies have found controlled cord traction reduces blood loss, while others found no increased risk with immediate manual removal. Overall, manual removal was associated with greater blood loss and infectious morbidity but shorter operative time.
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Uterine rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
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Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
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Mortality is low in LSCS scar rupture
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Subject - Midwifery & Obstetrical Nursing topic on Umbilical Cord Prolapse presented by mohammed haroon rashid
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
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An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
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• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
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The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
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Obstructed labour
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,
Ectopic pregnancy
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- An ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in the fallopian tubes.
- Risk factors include previous pelvic inflammatory disease, tubal surgery or infertility treatments. The most common site is the fallopian tube (95-96% of cases).
- Clinical signs can range from asymptomatic to acute abdominal pain and bleeding. Diagnosis involves transvaginal ultrasound, serum hCG levels and laparoscopy.
- Treatment depends on stability but may include expectant management, systemic or local methotrexate, or surgical
Retained placenta
The document defines and discusses retained placenta, which occurs when the placenta is not expelled from the uterus within 30 minutes of delivery. There are several potential causes of retained placenta, including failure of the placenta to separate fully from the uterine wall due to issues like uterine atonicity. Management involves controlling bleeding if present and attempting controlled cord traction or manual removal of the placenta in the operating room if needed. Leaving the placenta retained poses risks like severe bleeding.
Unstable lie
- 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.
mannual removal of placenta.pptx
This study evaluated risk factors and outcomes of manual removal of the placenta (MROP) at a tertiary hospital in Nigeria. The study compared 92 cases that underwent MROP to 91 matched controls. Risk factors for MROP included previous uterine scarring from procedures like dilation and curettage or cesarean section. Doctors performed MROP more often than midwives. On average, the third stage of labor was longer for those needing MROP. Establishing guidelines around diagnosing retained placenta could help reduce unnecessary MROP procedures.
Breech presentation
Breech presentation: definition, causes, types, diagnosis and management.
Lecture on Evernote: https://goo.gl/jkK9oK
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Placenta examination
The placenta provides nutrition and oxygen to the fetus and removes waste. It has both fetal and maternal components that form during embryology. A clinical assessment of the placenta after delivery examines characteristics like size, color, thickness, blood clots, completeness and the umbilical cord properties. Abnormal findings could indicate issues like fetal growth problems, infections, prematurity or bleeding that require further analysis. The assessment provides important information about the health of both the mother and baby.
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Retained placenta after vaginal delivery is diagnosed when a placenta does not spontaneously deliver within a designated amount of time, variably defined as a period of 18–60 mins. It may also be diagnosed if a patient experiences significant hemorrhage prior to delivery of the placenta. Normal placenta delivery requires adequate uterine contractions, with shearing of the placenta and decidua from the uterine wall and expulsion of the tissue. Thus, retained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions. History of a prior retained placenta and congenital uterine anomalies also appear to be risk factors. Management entails manual removal of the placenta with adequate analgesia, as medical intervention alone has not been proven effective. Complications can include major hemorrhage, endometritis, or retained portions of placental tissue, the latter of which can lead to delayed hemorrhage or infection. Prophylactic antibiotics can be considered with manual placenta removal, though evidence regarding effectiveness is inconsistent. If hemorrhage is encountered, deployment of a massive transfusion protocol, uterine evacuation with suction, and use of intrauterine tamponade, as with an intrauterine balloon, should be initiated immediately. When a separation plane between the placenta and uterus is particularly difficult to create, PAS should be considered, and preparations should be made for hemorrhage and hysterectomy. Patients with risk factors for retained placenta should have a laboratory sample sent for blood type and antibody screening on admission to labor and delivery, and plans should be made for appropriate analgesia and preparations for hemorrhage if a retained placenta is encountered.
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Caesarean section
The document discusses Caesarean section, including indications, types, procedure, complications, and mode of delivery in subsequent pregnancies. A Caesarean section is a surgical procedure to deliver one or more babies through incisions in the abdomen and uterus. The rate of Caesarean sections has increased from 5% in 1970 to 25% in 1990 due to factors such as abandoning difficult procedures in favor of C-sections and increased use for breech births. Complications can include hemorrhage, infections, and injuries to the mother or baby.
Vasectomy
The document provides information about vasectomy, including that it is a surgical sterilization procedure for men that involves cutting and sealing the vas deferens to prevent sperm from entering seminal fluid, as well as risks, procedure details, recovery expectations, and facts to consider before undergoing the permanent birth control method. Common misconceptions about vasectomy causing impotence or loss of sexual drive are addressed. Post-operative care and potential complications are outlined.
Uterine rupture
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Umbilical Cord Prolapse, Presented By Mohammed Haroon Rashid
Subject - Midwifery & Obstetrical Nursing topic on Umbilical Cord Prolapse presented by mohammed haroon rashid
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
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Selective cesarean myomectomy can be performed safely in selected patients to remove fibroids, according to their location and size. It is recommended to only remove accessible subserosal, pedunculated, or lower uterine segment fibroids. Techniques like uterine artery ligation and high dose oxytocin help decrease blood loss. Studies have shown no increase in complications like hemorrhage, infection, or longer hospital stay when performed by an experienced surgeon in a well-equipped hospital with blood available. Myomectomy during C-section may eliminate the need for future surgery and allow for vaginal deliveries. However, it should not be performed routinely and careful patient selection is important.
Abnormalities of-placenta-and-cordppt
This document discusses various abnormalities that can occur in the placenta and umbilical cord, including abnormalities in size, shape, insertion site and blood flow. It describes conditions like placenta previa, circumvallate placenta, succenturiate lobe, velamentous cord insertion and true/false knots that can impact fetal and maternal health. Diagnosis and management of these abnormalities is discussed.
Obstructed labour
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,
Ectopic pregnancy
Dr. Sourav Chowdhury provides a detailed overview of ectopic pregnancy in 3 pages of text. Some key points:
- An ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in the fallopian tubes.
- Risk factors include previous pelvic inflammatory disease, tubal surgery or infertility treatments. The most common site is the fallopian tube (95-96% of cases).
- Clinical signs can range from asymptomatic to acute abdominal pain and bleeding. Diagnosis involves transvaginal ultrasound, serum hCG levels and laparoscopy.
- Treatment depends on stability but may include expectant management, systemic or local methotrexate, or surgical
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The document defines and discusses retained placenta, which occurs when the placenta is not expelled from the uterus within 30 minutes of delivery. There are several potential causes of retained placenta, including failure of the placenta to separate fully from the uterine wall due to issues like uterine atonicity. Management involves controlling bleeding if present and attempting controlled cord traction or manual removal of the placenta in the operating room if needed. Leaving the placenta retained poses risks like severe bleeding.
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- 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.
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Placenta delivery during lscs
- 1. PLACENTAL DELIVERY DURING LSCS Dr gitanjali kumari Jr-3 Department of obstetric & gynaecology
- 2. • Two common methods used to deliver the placenta at CS are cord traction and manual removal. • Manual removal of the placenta which the obstetrician introduce his hand into the uterine cavity to cleave the placenta from the decidua basalis as soon as possible after the delivery of the infant • controlled cord traction in which the obstetrician do external uterine massage and gentle traction on the exposed umbilical cord to facilitate placental delivery. • Opinions differ about the best for placental delivery technique at CS. Some trials showed a reduced risk of blood loss with controlled cord traction and others showed that manual removal of placenta at CS do not increase perioperative blood loss. • It was concluded that manual delivery of the placenta was significantly associated with greater operative blood loss and greater decrease in postoperative hemoglobin levels and postpartum maternal infectious morbidity but with shorter operative time compared with spontaneous placental separation .
- 3. • Caesarean section rates are rising worldwide and becoming a cause for concern as caesarean section has been shown to be positively associated with maternal mortality and severe morbidity, even after adjusting for risk factors . • After delivery of the baby by caesarean section, it is common practice to administer intravenous oxytocin to the mother and deliver the placenta by controlled cord traction. • Massaging the uterine fundus may help to separate the placenta from the endometrium. • In this procedure, manual removal of the placenta is carried out only if there is a delay in its separation and expulsion. • An alternative method is to remove the placenta manually immediately after delivery of the baby. Although the latter approach may be quicker, it may increase the risk of significant blood loss and endometritis . Some studies, however, have not shown an increased risk of morbidity from immediate manual removal of the placenta
- 4. 1. Active bleeding 2. Uterus well retracted 3. Completeness of placenta
- 7. REMOVAL OF PLACENTA • After delivery of baby ,let the placenta separate on its own,don’t rush. • AMTSL should be DONE • An area near the fundus is felt spongy where placenta is attached -> after placental separation it becomes well retracted • Don’t unnecessarily mop the uterus ,mopping is associated with increased risk of endometriosis • See for uterine tone • Any active BLEEDING • See for placental completeness
- 8. • THANK YOU