OPERATIVE OBSTETRICS TERMINATION OF PREGNANCY Induction Of Abortion

OPERATIVE OBSTETRICS

TERMINATION OF PREGNANCY (Induction Of Abortion And Labor)

CERVICAL RIPENING Progress of labor

Misoprostol is a synthetic PGE 1 analogue 15 16 PG E 1 1 16 15 Misoprostol is (15 -deoxy-16 -hydroxy-16 -methyl PGE 1)

Amniohook for AROM ARTIFICIAL RUPTURE OF THE FETAL MEMBRANES (FOREWATER) (AROM).

Sweeping of Membranes

Induction of labor: - oxytocin IV drip - external tocography (record of uterine contractions) - fetal cardiotocography (record of fetal heart rate)

Operative Vaginal Delivery (Forceps And Vaccum Extraction)

Instrumental delivery= Operative vaginal delivery through use of : • Forceps. • vacuum extraction.

Obstetric forceps

The cephalic curve is adapted to provide a good application to the fetal head. The pelvic curve allows the blades to fit in with the curve of the birth canal.

Left Right TYPES OF FORCEPS Blade Pelvic curve Cephalic curve Shank Lock Finger guards Handle Simpson forceps

TYPES OF FORCEPS Simpson Braun

SIMPSON’S FORCEPS English lock [double slot lock]

Wrigley's Forceps is designed for use when the head is on the perineum and local anesthesia is being used. It is a short light instrument with pelvic and celphalic curves and an English lock.

The fetal head has reached the perineal floor and is visible at the vulva Engagement has taken place and the leading part of the head is below the level of the ischial spines

Kielland forceps Has cephalic curve, Has no pelvic curve. Sliding lock Pull the blade Correction of asynclitism

TYPES OF LOCK English lock sliding lock

correct cephalic application, with the head in the OA position. Delivery of the Head in the Occiput-anterior Position This is the easiest and often the best method of delivering an infant. If the head is low in the pelvis it is likely to be deliverable with vary little traction and the fetus is spared the risks of manipulation.

THAT APPLICATION SHOULD BE AVOIDED Before application rotation of the head should be fulfilled. Rotation could be achieved using manual rotation or forceps rotation by Kielland's forceps. Correct application prevent compression of the fetal head.

Cephalic application

Cephalic application (cont’d……)

axis traction rod pulling in the axis of the pelvic curve

CORRECT LINE OF FORCEPS TRACTION

CORRECT LINE OF PULL OF FORCEPS

Direct OP position. If the head is low in the pelvis it is likely to be deliverable with vary little traction and the fetus is spared the risks of manipulation. A large episiotomy is necessary

APPLICATIONS IN FACE PRESENTATION Forceps correctly applied along occipito-mental diameter of head in various positions of the occiput

TRACTION OF THE FETAL HEAD

APPLICATION OF ONE BLADE (LEFT SIDE) OF THE OBSTETRICAL FORCEPS

VACUUM EXTRACTION

Vacuum Application Applying the Malmstrom cup

Applying traction

OPERATIVE DELIVERY BY VACUUM EXTRACTION

TRACTION ON THE FETAL HEAD

chignon (shēn-yŏn') (hairstyle) Bruising and deformation of the scalp caused by vacuum extraction. “chignon” is a temporary swelling left on a newborn scalp after a ventouse suction cup. The terminology is used in comparison to a hairstyle. These are not sign of serious injury. They take few hours to a week to disappear.