BY DRSHUMAILA ZIA INDUCTION OF LABOUR DEFINITION Initiation of uterine contraction by artificial means prior to spontaneous onset leading to progressive dilatation amp effacement of cervix ampdelivery of baby ID: 930553
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Slide1
COMMON OBSTETRICAL PROCEDURES
BY
DR.SHUMAILA ZIA
Slide2INDUCTION OF LABOUR
Slide3DEFINITION
Initiation of uterine contraction by artificial means prior to spontaneous onset leading to progressive dilatation & effacement of cervix &delivery of baby.
Incidence=10-25%
Slide4Slide5Slide6METHODS 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.
Slide7METHODS 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
Slide8Slide9Slide10Slide11Slide12Slide13Slide14Slide15RISKS 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
Slide16Slide17TERMINATION OF EARLY PREGNANCY
Slide182- 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 .
Slide19Methods
: -
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 .
Slide20Medical induction :
Common after 14 weeks .
Mifepristone.
Extramniotic infusion .
Complication :-
Perforation .
CX laceration .
Retained products and sepsis .
Infertility.
CX incompetence.
Slide21Slide22Slide23Slide24Slide25Slide26Slide27Slide28Slide29CERVICAL CERCLAGE
Slide303.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.
Slide31Types 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.
Slide32Slide33Slide34Slide35Slide36Slide37Slide38Slide39Slide40Slide41Slide42Slide43THANK YOU