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Evolution of Human Birth and Delivery Practices

Explore the relationship between pelvis and fetal skull in primates and humans, highlighting the unique aspects of human birth, including delivery postures, support systems, and success rates of interventions. Discover intriguing cases like self-delivery and legal complexities in surrogacy.

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Evolution of Human Birth and Delivery Practices

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  1. February 2004

  2. Evolution of Human Birth

  3. Relationship of Pelvis to Fetal Skull Spider Monkey Proboscis Macaque Gibbon Orangutan Gorilla Chimpanzee HUMAN -Adolph Schultz

  4. Mento • Anterior • Extended Head • Delivers by extn • Non Rotational • Delivery • Narrow • Shoulders • Baby slips out Primate Delivery • Delivers in • Squatting posture • Reaches down & • Guides baby out of • Birth canal towards • Nipples • Infant assists by • climbing out • Wipes mucus • from mouth • Suckles stat!

  5. Human Posture at DeliveryStudy of 159 cultures-Trevathan 1987 • Sitting 47 • Kneeling 44 • Squatting 26 • Semi Reclining 17 • Lying Down 16 • Standing 9

  6. Fundamental Differencesin Human Birth • Habitual Bipedalism – Delivery Posture • High Encephalization Quotient • Occipito Anterior Position ( Fetus facing away from Mother’s pubes) • Rotational Delivery of Head & shoulders

  7. Fundamental Differencesin Human Birth • Obligatory Midwifery • Delivery in Social Context ( Versus Solitary in Monkeys ) • Physical & Emotional Support • Baby in ‘Altrecial’ state followed by ‘Exterogestation’ -BJOG Nov 2002

  8. TVT for Stress Incontinence • >100 Procedures • in 40 years • Rise &Fall of • -Antr Repair • -Bone Anchors • -Endoscopic Suspensions • TVT 1996 Ulmsten Stanton - Int Urogyn J 2001

  9. Bladder Neck Elevation Mid Urethral Support Urethral Compression

  10. SUCCESS RATE Intrinsic Sphincter Defect & Low Pressure Urethra 74% Mixed Incontinence 85% In Recurring SI 82% COMPLICATIONS Bladder Perforation 6% Voiding Difficulty 4% Haematoma Rare

  11. Results of TVT – Austrian RegistryObs Gyn 2001 • 2795 Patients – 55 Centres • 59% underwent isolated TVT – 41% with other Procedures • Median Operating Time: 30 mts • Anaesthesia: LA 44% - SA 43% - GA 12% • Most voided next day ( Catheter: Intermittent 24% - Indwelling 63% -Suprapubic 9%) • Complications: Bl Perf 2.7% ( 4.4% prev surg ) - Hematoma 19 - Re op 2.4%

  12. Cannibal finds a willing Victim No canines!

  13. Armin Meiwes: "Fantasy fulfilled" • Advertised on Internet - • >400 responded • Interviewed four • Selected Bernd Brandes • Killed,cooked,froze & ate 20kg • of flesh over several weeks • No Law against cannibalism • In Germany • Charged with Murder for • Sexual pleasure • Defence: Victim was willing • -He only abetted Euthanasia

  14. Woman delivers her own Grandchildren 46 year old mother became surrogate for her Indian immigrant daughter in UK with Rokitansky Syndrome and delivered Twins -News

  15. What is the Legal status in India? “Gestational mother is the legal Mother” • Grandmother becomes the Legal Mother of twins • Husband of legal mother is the legal father • Grandfather becomes the Legal Father • Genetic (real) mother becomes the twins’ sister • Genetic (real) father becomes the brother in law

  16. Is there a Solution? • The Genetic Parents must adopt the Twins • Can a woman adopt her sister as her daughter? • Can a man adopt his SIL as his Daughter? • But the Hindu Adoptions Maintenance Act 1956 says: • A Hindu married woman can adopt only if her husband is incapable of giving consent or ceased to be a Hindu • The genetic father’s wife can not adopt his child even if she is the genetic mother

  17. Obesity • BMI >30 (Kg/sq cm) Overweight: 25 - 29.9 - WHO– NIH Definition • Incidence in Females: 28% (>25 yrs) + 27% in others in US – 18% in UK – 40% of Married women in UAE • Obst Complications: Chr HT-PE-DM-CS-Infections-Thr Embolism-Resp Disorders • NN Complications: NTD-LGA-PNM-Childhood Obesity • Gynaecological / Surgical / Medical / Anaesthetic complications -Castro LC & Avina RL: Cur Opinion ObG Jan2003

  18. Obesity • 17% of Children • Between 13-18 years • Overweight or Obese • -WHO study in Chennai • 80% of obese children • Grow into obese Adults Michael 13 Himanshu 15

  19. Bariatric Surgery • Laparoscopic Application • Adjustable Silicon Band • At proximal portion of • Stomach to form pouch • Early satiety • Reversible • Up to 80% excess • wt lost in 2 yrs

  20. Bev & Deb 245 lbs July 02 125 lbs July 03

  21. Thank you!

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