COMMON OBSTETRICAL PROCEDURES

BYDR.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 INDUCTIONGeneral 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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