1. COMMON OBSTETRICAL PROCEDURESBY
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%

6. 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.

7. 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

15. 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

17. TERMINATION OF EARLY PREGNANCY

18. 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 .

19. 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 .

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

29. CERVICAL CERCLAGE

30. 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.

31. 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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