Operative Obstetrics: Richard G. Moutvic, MD, Facog
Operative Obstetrics: Richard G. Moutvic, MD, Facog
Operative Obstetrics: Richard G. Moutvic, MD, Facog
Midline Episiotomy
Lateral Episiotomy
Vaginal Lacerations
Bulbocavernosus
Transverse perineal
Puborectalis
Spontaneous
Induced
Treatment
Suction curettage
D and C
Medical Intervention
Spontaneous Abortion
Spontaneous
Threatened – bleeding in early gestation
Inevitable – bleeding with contractions
and dilation
Incomplete – products of conception
partially passed
Missed – dead fetus retained without
expulsion
Septic-Fever over 100.4F due to infection
(endo/parametritis-septicemia)
Spontaneous Abortion
Etiology
Developmental abnormality of zygote,
embryo,fetus, placenta
>50% degenerated or absent embryo
(blighted ovum)
60% abnormal chromosomes (>30% of 2nd
trimester Ab’s)
Hemorrhage into decidua basalis causes
necrosis
Ovum detaches, stimulates contractions
Spontaneous Abortion
Treatment
Observation
Diagnosis
o Abnormal uterine bleeding
o Pelvic Pain
o Positive Pregnancy Test
o Ultrasound
Ectopic Pregnancy
Ectopic Pregnancy
Surgical Treatment
o Laparoscopy, Laparotomy
Medical Treatment
o Methotrexate and others
Laparoscopic view
Female Pelvis
Pelvic Types
Pelvic Types
Gynecoid, Android, Anthropoid, Platypoid
Gynecoid Pelvis
Android Pelvis
Pelvic Measurements
Inlet
Midplane
Outlet
Mechanisms of Labor
Flexion
Descent
Internal Rotation
Extension
External Rotation
Explusion
STATION
-3
-2
-1
0 VTX @ Spines
+1
+2
+3
+4
Position of Fetal Head
29
OP, LOP, ROP, ROT, LOT
Fetal Position
Forceps
Position
BOW must be ruptured
Station
High Forceps >0 station
Mid Forceps> 0 - +2
Low Forceps +3
Outlet Forceps
Forceps
Indications:
Prolonged 2nd stage of labor
Progress has stopped
Inability to push due to anesthesia/analgesia
Fatigue
Contraindications
Fetal Coagulopathy
High station
Cephalohematoma
Scalp laceration
Intercranial hemorrhage
Neonatal jaundice
Skull fracture
Vacuum Extraction
Fetal coagulopathy
High station
43
Comparison of Forceps/Vacuum
IQ tested at age 17- no difference between
spontaneous delivery, vacuum or forceps
FDA showed 5% skull fracture in nulliparous woman
with over 3 pulls or “pop-offs”.
Forceps causes more 3rd and 4th degree
lacerations
Vacuum causes more retinal hemorrhages (no long
term effects)
Vacuum causes less maternal damage, more fetal
trauma
47
C-Sections
Classical Incision
Low Classical