COMMON OBSTETRICAL PROCEDURES

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Presentation transcript:

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 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.

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

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

TERMINATION OF EARLY PREGNANCY

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 .

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 .

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

CERVICAL CERCLAGE

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.

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.

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