妇产科学教学知识operativedeliveries.ppt

OPERATIVE DELIVERIES A- abdominal: caesarean section B- vaginal : 1. forceps delivery 2. vacuum extractor or assisted ventouse delivery delivery 3. breech delivery 4. destructive operations 5. episiotomy DEFINITION Operative delivery denotes any obstetric procedure in which active measures are taken to accomplish delivery. The success of such a procedure depends on the skill and /or experience of the operator. The timing of such an intervention must be in the interest of both the mother and the baby. CAESAREAN SECTION Definition: This is delivery through an abdominal route by an incision on the abdominal wall and the uterus after 28 weeks of gestation. Historical Notes It is generally said that the operation originated from the decree ”lex Caesarea” under the rule of the Caesars which stipulated that before burial of the mother, the child be removed from the uterus of any woman dying in late pregnancy. Others think it originated from the Latin word “caedere” meaning to cut. The first caesarean section was carried out in 1610 and the first successful one in 1794 in the USA. Early caesarean sections were associated high maternal and fetal mortality because of haemorrhage and sepsis. TYPES OF INCISIONAL CAESAREAN SECTIONS ?Classical Caesarean Section ???Lower Segment Caesarean Section ???Caesarean Hysterectomy ???Extra-peritoneal Caesarean Section. Classical Caesarean Section Advantages: It is easy to perform. Today it has very limited indications (conjoint twins, post-mortem, varicose veins and adhesion over the lower segment, impacted neglected shoulder presentation). Disadvantages: associated with increased bleeding, increased risk of rupture in subsequent pregnancy and increased risk of intestinal obstruction. Lower Segment Caesarean Section isthmus uteri---- the lower segment Three types of incision can be done on the lower segment. A- Transverse incision: Adva