Medical brain Notes 3

  Forceps Delivery   Forceps delivery is a means of facilitating the birth of the baby's head by providing traction and rotation with the aid of obstetric forceps when it is impossible for the mother to complete the delivery by her own effort.   Forceps deliveries are classified by the level of the head at the time the forceps were applied i.e. high-cavity, mid-cavity or low-cavity.   Low-cavity  or out let forceps applications are done when thefetal head is visible on the perineum.     Mid-cavity  or Mid forceps applications are for those in whichthe head is at the level of ischial spines and engaged.   High-cavity  or High forceps applications are those in whichforceps are applied through the cervix before the head is engaged in the bony pelvis.   Pre requisites of forceps delivery   There are certain conditions which must exist before forceps application including those conditions that require a shortened second stage labour...

  Caesarean Section   Caesarean section is an operative procedure in which the fetus is delivered through a surgical incision in the maternal abdominal wall and uterus. The primary goal of caesarean delivery is the preservation of the life and well-being of both mother and fetus.   There are two major types of caesarean section: the lower segment and classical caesarean section.   A. The lower segments caesarean segment  – the skinincision is made horizontally, suprapubic called a ptannenstiel incision or the "bikinicut” and incision is made in the lower segment of the uterus after about 32 weeks of gestation and is less muscular that the upper segment of the uterus. Since skin incision is low it is latter hidden by pubic hair.   Advantage This heals more rapidly and success fully   Blood loss is minimal, few post delivery complications occur The incision is easy to repair. Less chance of rupture from the uterine scar in future pregnancies.   Disa...

  Destructive Operations /Embryotomy/   It may occasionally be necessary, in the interest of saving the mother's life, to destroy the fetus. These drastic measures will only be undertaken if there is gross fetal abnormality causing fetal pelvic disproportion. The alternative is caesarean section. The fetus may be equally difficult to deliver abdominally and may still need to be destroyed first. What ever the situation it is traumatic for all concerned and calls for sensitive support of both the family and the staff.   The instruments used for destructive operations are of necessity brutal and must be used with great care to avoid injuring the mother.   The main operations are; Decapitation, craniotomy, evisceration and cleidotomy.   Decapitation  – may be necessary when a shoulderpresentation has become impacted. There are also varioustypes of decapitating hooks and knives which may be encountered. The operation consists of severing the fetal head from the ...

  Version   Version is the manipulation of the fetus to obtain a more favorable presentation of the baby. E.g. From breech to vertex   Type of Version   External version - Used to change the presentation in to cephalic. Internal version - Used to make the presentation in to breech and extract the baby.   1. Internal Version     It is the direct manipulation of the fetus inside the uterus. It is usually done to convert the malpresentation of second twin. Internal version poses significant risk to the fetus and is now done only in extreme emergencies, such as profound fetal distress with a prolapsed cored or the need for the immediate delivery of a second twin when there is not enough time for caesarian delivery.   In this procedure the physician reaches up into the uterine cavity grapes feet of the fetus and draws them through the cervix and delivers the fetus as in breech presentation. Thisprocedure is extremely rare in contemporary obstetric prac...