Medical brain notes 11

  Introduction   Normally a baby should be delivered spontaneously per vaginam with little assistance from the attendants, but this is not always the case. Sometimes the baby has to be delivered through surgical assistance with the use of forceps, vacuum extractions or by Caesarean section. The needs for this operation intervention are multifactoral as you shall discover as we go into discussion in this unit. The techniques involved in each of the methods and the midwife’s role will be highlighted.   Objectives   By the end of the discussion in this unit you will be equipped with skills to be able to   ·                Assist in operational procedures in obstetrics   ·                Counsel these women on the need for surgical intervention when the needs arise   ·                Reduce the risk of likelihood of caesarean section .   ·                Ensure that appropriate post delivery care for both mother and baby   ·                Provide psychological support for women who had in

  Episiotomy /Perineal Laceration   An episiotomy is a deliberate surgical incision made into the perineum to enlarge the vaginal orifice (intritus) to facilitate the birth of the baby. It is a planned surgery but often, it is performed as an emergency, because the need for it may not be apparent until the second stage.   Indication: 1.             To minimize severe spontaneous maternal trauma.   2.             Delay 2 nd  stage – Tear is imminent, Disproportion, Rigid perineum, Contracted outlet, abnormal positions e.g. opp; face to pubes delivery.   3.             Fetal distress – e.g. prolapse cord. To hasten the delivery of the head.   4.             To facilitate vaginal and intrauterine manipulation e.g. foreceps and intrauterine manipulation e.g. forceps delivery, ventouse extraction, breech delivery.   5.             Preterm babies – to avoid intracranial damage.   6.             Previous complete perineal tear   7.             Primipara with big baby.       Types 1. Media :