1 / 36

Operative DELIVERIES

Operative DELIVERIES. Saeed Mahmoud, MRCOG,MRCPI,MIOG,MBSCCP Assistant Professor & Consultant Department of Obstetrics & Gynecology College of Medicine King Saud University. Operative Deliveries. 1.Instrumental deliveries A. Vacuum /Ventouse B.Forceps 2. Cesarean Section CS, C/S.

ccowan
Download Presentation

Operative DELIVERIES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Operative DELIVERIES Saeed Mahmoud,MRCOG,MRCPI,MIOG,MBSCCP Assistant Professor & Consultant Department of Obstetrics & Gynecology College of Medicine King Saud University

  2. Operative Deliveries • 1.Instrumental deliveries A. Vacuum /Ventouse B.Forceps • 2. Cesarean Section CS, C/S

  3. VACUUM /VENTOUSE

  4. INDICATIONS MATERNAL • Exhaustion • Prolonged second stage • Cardiac / pulmonary disease FETAL • Failure of the fetal head to rotate • Fetal distress in the second stage

  5. Conditions to be fulfilled : MNEMONIC • A – Anesthesia adequate • B – Bladder cathterization • C – Cervix  fully dilated / membranes ruptured • D – Determine  position, station, pelvic adequacy • E – Equipment  inspect vacuum cup, pump, tubing,  check pressure

  6. MNEMONIC • F – Fontanelle  position the cup over the posterior fontan  low pressure 10 cm H2O initially & between cont  sweep finger around cup to clear maternal tissue  ↑ pressure to 60 cm H2O with the next contraction • G – Gentle traction  pull with contractions only traction in the axis of the birth canal ask the mother to push during cont

  7. MNEMONIC • H – Halt  halt traction if no progress with three traction aided contractions vacuum pops off three times pulling for 30 min without significant progress • I – Incision consider episiotomy if laceration imminent • J – Jaw remove vacuum when jaw is reachable or delivery assured

  8. Key points • Vacuum –assisted delivery is less traumatic to the mother & fetus than forceps • Ventouse should be the instrument of choice • Should not be used for preterm, face presentation or breech

  9. COMPLICATIONS • Maternal  Vaginal laceration due to entrapment of vaginal mucosa between suction cup & fetal head • FETAL • Scalp injuries  abrasion & lacerations 12.6% scalp necrosis 0.25-1.8% • Cephalohematoma  25%  jaundice /anemia • Intracranial hemorrhage  2.5% • Subgaleal hematoma

  10. Fetal Complications

  11. FETAL COMPLICATIONS • Birth asphyxia  2.6-12%  related to extraction force & time Some studies showed decrease birth asphyxia • Retinal hemorrhage 50% Forceps 31% SVD 19% • Neonatal jaundice

  12. FETAL COMPLICATIONS • Fetal mortality 15/1000 Lower in cases delivered by vacuum 1.9%/ forceps 5.2 % No long term effects on neurological psychomotor or intellectual development up to 4 years of age

  13. FORCEPS

  14. INDICATIONS MATERNAL • Exhaustion • Prolonged second stage • Cardiac / pulmonary disease FETAL • Failure of the fetal head to rotate • Fetal distress • Control of the fetal head in vaginal beech delivery

  15. CLASSIFICATION OF FORCEPS DELIVERY • Outlet forceps  Scalp visible at the vulva without separating the labia • Low forceps  Vertex at +2 station

  16. Midforceps  Head is engaged but leading part above +2 station  Sagittal suture not in the AP plane of the mother

  17. CLASSIFICATION OF FORCEPS DELIVERY • Outlet  Wrigley’s • Outlet & low forceps  Simpson /Elliot • Midforceps & outlet  Tucker Mc lane • Midforceps & rotation  Kielland • After coming head in breech  Piper

  18. Conditions to be fulfilled : MNEMONIC • A – Anesthesia adequate /epidural or pudendal • B – Bladder cathterization • C – Cervix  fully dilated / membranes ruptured • D – Determine  position, station, pelvic adequacy • E – Equipment Know your forceps

  19. MNEMONIC • F – Forceps phantom application Lt blade , LT hand, maternal Lt side pencil grip & vertical insertion with Rt thumb directing blade Rt blade , RT hand, maternal Rt side pencil grip & vertical insertion with Lt thumb directing blade Lock blades

  20. MNEMONIC Check application: • Post fontanelle 1cm above the plane of the shanks • Sagittal suture lies in the midline of the shanks /perpindicular to the plane of the shanks • The operator can not place more than a fingertip between the fenestration of the blade & the fetal head on either side

  21. MNEMONIC • G – Gentle traction  applied with contraction & maternal expulsive efforts • H – Hand elevated  traction in the axis of the birth canal • I – Incision  consider episiotomy if laceration imminent • J – Jaw  remove forceps when jaw is reachable or delivery assured

  22. COMPLICATIONS • Maternal  trauma to soft tissue 3rd/4th degree double the risk compared to ventouse bleeding from lacerations trauma to urethra & bladder  fistula Pain 17% ventouse 11%

  23. COMPLICATIONS • Fetal  bruising & laceration to the face  Injury to the fetal scalp cephalohematoma 9% Vent 25% retinal hemorrhage 30% Vent 50%  skull fracture permanent nerve damage / Facial nerve The risk of shoulder dystocia is increased following instrumental deliveries

  24. CESAREAN SECTION CS

  25. TYPES OF CS • Lower segment CS • Classical CS

  26. INDICATIONS FOR ELECTIVE CS • Repeat CS • Placenta previa • VV fistula repair • HIV (poor controlled) • Active herpes • Fetal macrosomia > 4500 gm • Uterine surgery eg. Hystrotomy, myomectomy • Severe IUGR • Breech • Multiple pregnancy • Transverse lie • Ca of the Cx/ TR obstructing the birth canal

  27. Indications for classical CS • Transverse lie back down (with SROM) • Structural abnormality that makes lower segment approach difficult (Fibroids) • Anterior Placenta Previa & abnormally vascular lower segment • Poorly developed lower segment in Very preterm fetus in breech presentation • Cervical cancer

  28. TIMING OF ELECTIVE CS • Usually at 38-39 wks

  29. COMPLICATIONS • Bleeding & the need for bl transfusion • Hysterectomy • Complications of anaesthesia • Damage to the bladder, ureter, colon , retained placental tissue • Fetal injury • Infection • DVT/PE

  30. MODE OF DELIVERY IN NEXT PREGNANCY CRITERIA FOR VBAC • Pt must agree to the procedure • A low transverse uterine incision • Non recurrent cause of the previous CS • No macrosomia, malposition, multiple gestation, breech

  31. CONDUCT OF LABOUR Observe for • Progress • Fetal wellbeing • Maternal well being • Epidural • HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

  32. Risk of SCAR RUPTURE • O.5% for LSCS • 4-9% for classical

  33. SCAR RUPTURE Signs OF SCAR RUPTURE • Fetal distress • Ease of fetal palpation • Cessation of contractions • Elevation of presenting part • Scar pain • Bleeding / shock

  34. Thank you Any Questions

More Related