Презентация на тему Obstetric procedures

sampling.
External cephalic version.
Operative vaginal delivery:
Forceps.
Ventouse.
Cesarean section.

age by CRL (one of most accurate indicators of

fetal age).
Presence or absence of fetal life.
Fetal no.
Evaluation of the uterus (include cx ) and adnexal structures (fibroid and ovarian cyst.

number , and presentation.
An estimate of the amount of

amniotic fluid (< > N) .
Placenta location.
Assessment of gestation age.
Evaluation of the uterus and adnexal path.
Fetal anatomy.

fluid from the uterine cavity using a needle via

atransabdominal approach.
Indications
Diagnostic indications ex. Prenatal genetic studies.
Ass. Fetal lung maturity.
Fetal infection.
Degree of hemolytic anemia.
Blood or platete type.
NTD
coaglopath.
Therapeutic procedure.( remove excess fluid ).
Hemoglobinopath.

of membranes .
Fetal injury (direct ,indirect ).
Infection . (

hepatitis ,toxo , CMV, HIV,).
Fetal loss 0.5 -1 %. (significantly affected by maternal age ).
Amnionitis 1/1000.

Cont. Amniocentesis:

are taken sent for genetic analysis , provides preliminary

cytogenetic results within 48h and final culture result within 7 days.
Time: 10 -12 weeks .
Complications : similar to amniocentesis .
Approach:
1.Transcervical.
2.transabdominal. ( depend on placenta site ) .
Contraindications:
1.Vag. Bleeding.
2.Active genital tract infection.
3.Extreme ante – or retroflexed uterus.

.
Previous child with non- disjunctional chromosome abn.
Parent is carrier

of balanced translocation or other chromosome disorder.
Both parents are carriers of autosomal recessive disease.
Women who are carriers of a sex – linked disease .
Positive first – trimester screen for trisomy 21 or 18 .

red cell or platelet alloimmunization.
Analysis of non – immune

hydrope.
Karyotyping of fetal blood and congenital infection.
Analysis of metabolic & hematological status.
Procedure:
The operator punctures the umbilical vein , usually at or near its placental origin.

As amniocentesis.
Cord hematoma.
Cord vessel bleeding.
Fetal – maternal hemorrhage.
Fetal

bradycardia.
Fetal death.

curve )
Shank.
Lock. (sliding lock , English lock )
Handle.
Function of

forceps:
Traction.
Rotation.
Both.

disease , pulmonary inj. Or compromise.
Intrapartum infection.
Exhaustion.
Prolonged second stage

of labour.
Certain neurological condition.
Non- reassuring CTG.
Prolapsed cord , premature separation of placenta.

cx.
Mb ruptured.
Role out CPD.
Local or regional anesthesia.
Bladder should be

empty.
Expert operator.

anal dysfunction.
Febrile morbidity.
Low Apgar score.
Cephalohematoma.
Caput.
Facial nerve injury.
Fetal truma (

Erb palsy ,fratured clavicle ).
Retinal hemorrhage.

cup ).
Indications &prerequisites:
as forceps.
Contraindications:
Inexperience.
Inability to ass. Fetal

position.
High station.
Suspicion of CPD.
Non vertex presentations.
Fetal coagulopathy.

sampling.
Vacuum extraction is reserved for fetus 34 weeks or

older.
Complications:
Scalp lacerations & bruising.
Subgaleal hematoma.
Cephalohematomas.
Intracranial hemorrhage.
Neonatal jaundice.
Subconjuctival hemorrhage.
Clavicular fracture.

c/s.

Utrine segments:
Upper uterine segment .(active seg. ) contacts ,retracts

,expels fetus ,mainly muscular.
Lower uterine segment .( passeve seg. ) dilate ,expande ,thinned –out . Fibromuscular .
So lower & upper seg. Differ anatomically & physiologically.

incision ).
Uterine incisions:
Lower uterine segment transversely incision.
Lower uterine segment

vertical incision (may be used).
Upper uterine segment vertical incision ( classical incision) . Rare.
Indications for classical c/s :
Can not expose lower seg.
Transverse lie ,large fetus ,rup. Mb.

(ant.) .
4. Some cases small ,breech ,premature .
5. Some

cases massive obesity when upper seg. Accessible.
Advantage of LSCS:
Easier to repair .
Less likely to rupture during subsequent pregnancy .
Dose not promote adherence of bowel or momentum at the incision line .
Less bleeding .

maternal death.
Bleeding.
Infections.
DVT.
Adhesions.
Pain.

blood loss .
Fewer transfusion.
Fewer infections.
Fewer DVT.
Risk of VBAC:
Uterine rupture.
Hysterectomy.
Increase

morbidity .(b.tran.).
Fetal death or damage.

Available.
NO contraindications for vag. Delivery.
No other uterine scare.

ECV )
Definition: It is a procedure by which an

obstetrician turns the baby from the breech to the cephalic position by manipulating the baby through the maternal abdomen .
The procedure increases the chance of cephalic presentation at onset of labor and decreases the rate of cesarean delivery.

and offered to women with breech presentation at term

.
Risk : Discomfort , ERC/S , Transient bradycardia is less common ,placental abruption , premature labor .
Cost : cost-effective .
Contraindications :
Indications for c/s .
Rupture membranes .

extended fetal head.
5. Significant fetal or uterine anomaly

.
6. Abruptio placentae .
Relative contraindications :
Previous c/s .
Maternal hypertension, obesity .
IUGR.