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COMMON OBSTETRICAL PROCEDURES

COMMON OBSTETRICAL PROCEDURES. BY DR.SHUMAILA ZIA. INDUCTION OF LABOUR. DEFINITION. Initiation of uterine contraction by artificial means prior to spontaneous onset leading to progressive dilatation & effacement of cervix &delivery of baby. Incidence=10-25%. METHODS OF INDUCTION.

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COMMON OBSTETRICAL PROCEDURES

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  1. COMMON OBSTETRICAL PROCEDURES BY DR.SHUMAILA ZIA

  2. INDUCTION OF LABOUR

  3. DEFINITION Initiation of uterine contraction by artificial means prior to spontaneous onset leading to progressive dilatation & effacement of cervix &delivery of baby. • Incidence=10-25%

  4. METHODS OF INDUCTION Medical methods. • Prostaglandins: PGE2(Prostin,3mg), PGE1(cytotec,200 micro gm), PGF2-alpha • Oxytocin(5iu,10iu). Surgical method: ARM. Mechanical methods: Sweeping of membrane. Mechanical traction.

  5. METHODS OF INDUCTION - Cont. • Medical induction and cervical ripening • Methods of choice when the membranes are intact or unsuitable of surgical induction . • Syntocinon infusion . • Administration of prostaglandins, by various Routes(E2) • Orally • Vaginal Routes

  6. RISKS OF INDUCTION General risks: .Failed induction. .Iatrogenic prematurity. .Difficult labour. .C-section. Method related: • Prostaglandin: .Ut. Hyperstimulation. .N,V,D &fever. • Oxytocin: .Ut. Hyperstimulation .Fetal distress. .Water intoxication. .Amniotic fluid emb. • ARM: .Cord prolapse. .Placental abruption. .Cervical& uterine trauma .Infection

  7. TERMINATION OF EARLY PREGNANCY

  8. 2- Early Termination Of Pregnancy • It requires two doctors agreement that either continuation of the pregnancy involve great risk to physical or mental health of mother / her other children than termination .Or fetus at risk of an abnormality and result inbeing seriously handicapped . Indication For Termination : • Risk to the life of mother would be greater if pregnancy continues. • To prevent permanent harm to mental or physical health of mother . • Risk of mother health, greater if pregnancy continue . • Risk to other children in the family if pregnancy continue . • Risk of serious disability in the child .

  9. Methods : - • All women should be screen of STD - antibiotics offer . • Anti-D immunoglobulin (Rhesus -ve women ). • FU appointment and contraception . • - Surgical Termination :- • D&C . • Suction curettage . • Anesthesia • Piece meal removal of larger fetus . • Administration of prostaglandins before operation .

  10. Medical induction : • Common after 14 weeks . • Mifepristone. • Extramniotic infusion . Complication :- • Perforation . • CX laceration . • Retained products and sepsis . • Infertility. • CX incompetence.

  11. CERVICAL CERCLAGE

  12. 3.Cervical incompetence cervical cerclage . Cervical incompetence results in mid trimester spot. Miscarriage or early preterm labour .Tends to be rapid ,painless and blood loss. Diagnosed by : - Passage of hegar dilator without difficulty in non pregnancy . - U/S . - Pre menstural HSG. Causes : - Congenital - Damage by D&C or during child birth . Treatment : - Cervical cerclage 14-16week. - U/S C.Indicated: - Rupture membrane ,died fetus . Removal: - 37/52 if ok - Any emergency labour pain, rupture membrane ,IUFD.

  13. Types of cervical cerclage Transvaginal approach: • . MacDonald suture. • . Shirodkar suture. Transabdominal cervical cerclage: • . Anatomical defect of cervics • . Previous mid trimester miscarriage following failed vaginal cervical cerclage.

  14. THANK YOU

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