Section- group of opertion tht finish lbour withlprotomy

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Obstetrics and Gynecology

*Obstetrics operations*
*Lec 14*

We do this operations when the women doesn’t start labour spontaneously.

Groups of obstetrics operations:

1.  C-section: group of operation that finish labour withlaprotomy.
2.  Forceps operation: operation when the women begins labour spontaneously pelvis naturalis – by extracting the fetus from the genital tract and it is done via vagina.
3.  When the fetus have bridge presentation – special traction.
4.  Operation for rupture fetus by part – operation is conducted when labour did not start spontaneously and the baby is already dead.
5.  When women have late pregnancy – late term pregnancy some operations in early terms of pregnancy – when women have pathological condition of uterus – cervical insufficiency – when there is cervical dilation – when labour begins to rupture – when begins next pregnancy cervical canal opens and causes spontaneous abortion – isthmuca cervicalis insufficiency we must stitch the cericum and isthmus of the column uterus – should done before 21 weeks of pregnancy by “Lubimova”  - circuferance stitch of mucus of patient of cervical canal and 2 weeks before the delivery we remove the stitch and spontaneous labour begins.
6.  Operation of “Scendy” when we stitch cervical canal step by step, cervical canal is closed and begins normal term of pregnancy before labour remove the stitches (suction) and dilation.
7.  C-section per vagina: it should be done if fetus is very small 21st -22nd week of pregnancy suction lower part of uterus.
8.  Operation by “Tret” before 32 week of pregnancy, for rotation of fetus, it is done if bridge presentation, transverse or oblique position done by special manipulation with hands of doctor, the doctor begins to fixation of fetus to normal position (caput presentation) then women will have spontaneous labour.

C-section operations:

1.  C-section of lower segment of uterus:
2.  Optimal technique because uterus is sectioned and lower segment.
3.  1cm incision and dilation with fingers on both sides.
4.  Doctor begins to relax women  by giving narcosis (endotracheal or spina lumbalis) when spina lumbalis women is awake but without any pain sensation and she is relaxed, in endotracheal women is unconscious.
5.  Section of cutaneous fat, aponeurosis (transverse position).
6.  Dilation of muscles as on the anterior abdominal wall (rectus mucles)  in vertical position after section of this muscle then section of peritoneum.
7.  We can see the uterus, section peritoneum part of uterus then section of uterus for 1 cm and then 2 fingers are used to dilate.
8.  Evacuation of caput and fetus, placenta, and amniotic sheath.
9.  Stitch uterus and other sheaths.
   
10.  Corporal C-section:
11.  We section all anterior surface of the uterus in longitudinal incision.
    

Operations when fetus have Bridge presentation:

1.  When women have bridge presentation mechanism of labour 6 movements.

Operations when fetus have foot presentation:

1.  If foot prolapsed form the vagina then we do evacuation of the fetus.
2.  Internal rotation of the buttocks.
3.  Internal rotation of the body.
4.  Internal rotation of the shoulders and etc.

Forceps operation:

1.  It have 2 variants:
2.  When caput on cavity of small pelvis.
3.  When caput on the exit of uterus.
   1.  First insert the left forceps to the left side and then insert the right forceps to the right side this will fix the caput.
   2.  Then traction of the fetus.

Operation when fetus died or did not born spontaneously:

1.  Decapitation – when cervix part of fetus > rotation > rupture of the cervix.

Perforation of the caput:

1.  If fetus have bigger caput in case of hydrocephalous in this case fetus doesn’t descend in small pelvis.

Cranioplasia:

1.  Crainoplast is an instrument used. It is little different from forceps – we put one branch in forearm and 2nd part on the external part of the caput of fetus.  

Vagoextraction of fetus:

1.  Operation of fetus we have special little metallic/ plastic cup which fixes the caput and special vacuum apparatus when between caput and cup begins negative  atmospheric pressure that leads to fixation of caput and then excavation of fetus.

Operation if women have wound at perineum:

1.  We use anesthesia, infiltration anesthesia anterior pudendus when rupture of column of uterus we should do para cervicalis anesthesia.

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