Obstetrical Surgery

an procedure to help / overcome the

problems that occurs during the
delivery process.
 Episiotomy
• Definition
A surgically planned incision on
the perineum and the
posterior vaginal wall during
the second stage of labour.
• Purpose
– To enlarge the vaginal
introitus
– To facilitate easy & safe
delivery
– To minimize rupture of the
perineal muscles & facia.
– To reduce stress on fetal
head.
 Cunam Extraction
• Definition
an act of help childbirth in which a fetus were born
with a pull with cunam / forceps mounted on his
head.
• Indication:
– Mom : Eclampsia/pre-eclampsia, asthma,
rupture uteri, etc
– Baby : fetal distress
• Contra indication
– Premature
– Cephalopelvic dislocation
• Requirements
– Aterm
– The baby can be delivered
normally
– Cervix fully opened
– Engaged fetal head
– The water had broke
• Complications:
– Mom : bleeding,
ripping the birth canal, a
fistula, fracture the bones
of the pelvis, infection
– Baby : forceps bruise on
the head, the bones of
the skull fracture,
bleeding intracranial,
from nervous facial,
asphyxia / suffocated,
until the death of the
fetus
• Procedures:
– Preliminary application mode.
– Inserting the left blade using the left hand, into the mother’s left sacral
cavity, to grab the left parietal bone of the child (Quartet rule of Dennen).
– Inserting the right blade using the right hand, into the mother’s right
sacral cavity, to grab the right parietal bone of the child (Quartet rule of
Dennen).
– Closing and locking the forceps blades.
– Digital checking for correct positioning, followed by a first trial traction.
Correct positioning if necessary.
– Holding the forceps in position for definitive traction.
– Biparietal position of the forceps on the child’s head.
– After preliminary episiotomy, and with good contractions, the forceps are
pulled steeply down until the neck hairline appears, then slowly upwards
to complete delivery of the head (see arrows). The child is delivered
manually afterwards.
 Vacuum Extraction
• Definition
– An act of help childbirth in
which a fetus born with
extraction use negative
pressure with a vacuum
(negative-pressure vacuum
an extractor) installed in
his head.
• Indication
– The need to help
accelerate stage two of
childbirth, because if late it
could jeopardize the state
of mother and / or fetus.
• Contraindication
– Cephalopelvic disproportion
– ruptura uteri
– the mother may not straining
due to heart disease,
preeclampsia, asthma, etc.
• Requirements
– Aterm
– The baby can be delivered
normally
– Cervix fully opened
– Engaged fetal head
– The water had broke
– Mom has to strain
• Delivery with vacuum extraction :
– after the cup is attached to the
baby’s vertex (or hip / buttock in
breech presentation), the negative
pressure is increased, then the
extractor is pulled according to the
rhythm of the mother’s contractions.
– Prior episiotomy might be required.
– The direction of traction, as in normal
vaginal or forceps delivery, is first
slightly downward, then forward and
then slowly upward, following the
curvature of the pelvis.
– When one hand is pulling, the other
hand should help to suspend the
mother’s perineal region to prevent
further perineal rupture.
 Sectio Caesarea
• Definition • Indication
– An act of help childbirth
in which a fetus was born
through a incision is on
the wall the stomach and
the lining of the uterus.
• Requirements
– The uterus intact so in
sectio cesarea, the uterus
will be incised)
– Weight of the fetus is
over 500 grams.
– the state of being precluded a fetus was
born per vaginam, and / or a state of
emergency that requires terminations
pregnancy / childbirth immediately, that
is waiting for progress childbirth per
vaginam physiologically.
– Mother: pelvic narrow absolute, tumors
n the birth canal that may cause
obstruction, stenosis of cervical / the
vagina, placenta previa, disproportion
cephalopelvic, ruptura uteri.
– fetus: abnormality position, prolapse
umbilical cord, fetal distress.
– Generally sectio cesarea was not done
at the state of a dead fetus, mother
shock / severe anemia who have not
handled, or on the fetus withmajor
congenital abnormality.
• General procedures
– vertical midline incision of the skin between
the umbilicus and the pubic symphisis,
followed with layer-by-layer separation of the
subcutaneous fat, muscle, fascia and
peritoneum of the abdominal wall.
– After the gravid uterus is exposed, the
peritoneal sheet between the anterior wall of
the uterus and the upper / posterior wall of
the urinary bladder is identified and cut, and
then separated. The lower midline region of
the anterior uterine wall is then cut with a
small sharp incision.
– Through the small incision, the uterine wall is
divided further laterally using the operator’s
fingers. The amniotic membrane is then cut to
gain access to the uterine cavity.
– Delivery of the baby and the placenta.
– Closing repair of the uterine wall, using
double / two-layer sutures recommended.
The bleeding in the uterine cavity must be
controlled first before these repairs.
– Closing repair of the peritoneum, followed
with layer-by-layer closure of the abdominal
wall.
• Complication
– mother: infection,
postpartum bleeding.
– fetus: depression the
arrangement of the CNS
of a fetus caused by
defendants use of
anesthesia ( fetal
narcosis ) .