Most of the tmes the bag of membranes rupture after 10 cm dilatation.
But in ARM can insert forceps and pull and tear it.
Cervical ripening because it helps release prostaglandin
crowning is when the head appears out of the introitus and doesnt recede back. if it reced back then sign of shoulder dystocia?
its curved because to avoid cutting in the midline so anal spinctres or rectal mucosa isnt cut.
Must make sure to suture the apex of the vaginal lesion as well. If we miss this it will lead to bleeding and hemotoma formation. So start taking bites from the above the apex of the vaginal lesion.
start from a cm above the apex. Then suture the vaginal mucosa. then the muscle layer in between. and then lastly the skin is sutred.
suture materials depends. find out the suture material in your intsitute.
banagala notes summary see.
absordable sutures are used here
to avoid anal sphincture inuries in case need to extend the incision
routine epiphysiotomy to all women have not been shown to reduce likelihood of perineal injuries ...
others uses of the catheter are improvised as torniquet for myomectomy, cervical ripening, in prevention of intrauterine adhesion post adhesiolysis, etc
cervical ripening usage has been explained in the induction of labour lecture.
To diffeirenciate between kielland forceps and simpsons forceps ...look at the locks.
Kielland no longer use becase rotational manouvres of the head no longer done in obs
Place them on the table and try to hold them straight and see whether they interlock or not....they will be like the above and interlock if its the right side.
consent taken and bladder emptied after the first crteiria is met.
Left blade is inserted first. Right hand is placed below vagina so it doesnt hurt the vagina. And then assistant will hold it while you put the other forcep and then you lock it,
If they get easily lcoked then it means you've applied them correctly. If not then somethings wrong. Dont force them together and dont apply traction of they arent loced properly.
reconsider and repply if not put correctly.
the blades should be equidistant from the suture/
continious traction needs to be applied. not bit by bit or intermittent. should be continoous and should hold the blade in the middle...not too close and not too far. and appy tractions in the directions of the brith canal. first down, then middle then up.
the right end of the silicon cup is attached to the vaccum creating machine in the labour room.
higher pressure is avoided to avoid fetal scalp injuries
clinical hint to whether cup has been properly attached ⇒ see whether rim is at the posterioir fontanelle ad the anterioir fonatnelle is 2 finger breathes (3cm) below the lower rim.
after toileting done, use sims to access the cervix, and then use sponge holding forceps to hold up the cervix lips...and then insert the cupt like below along the sims. after that remove the sponge forceps and then push up the abdomen to raise and straighten the uterus
the pushing on the abdomen, raising the uterus is ain importance step to straighten the uetrus and allow easy insertion.
Yo go up, until you feel it on the fundus
and then you open the kellys forceps and put it to the right and pull it out sliding against the lateral walls ... you open slightly so that the strings dont get entangled
unlike intevral replacements of iucds, where the thread can be seen coming out from the vagina, and then you have to cut it short, in this case the threaad should not be seen. IF its seen then you've not inserted it fully!
must insert these after episiotomy repair.
why within 10 mins? because after 10 mins the os gets closed.
uetreus wall at term is very thin and easil rptrable!
the kellys forceps is rounded to reduce the risk of ruptre!
hand on the abdomen is the guide whether reach fundus or not. Mst push from above so once reach the fundus will feel a resistance.
mltiple attempts at different modes of intrmenta delivery isnt preferred. can try intruments twice and see or vaccum twice or thrice bt dont try forceps after vaccum or vacuum after forceps. just take for ceasarian.
LOT is most common followed by LOA
in suturing of 3rd or 4th degree block, we sticch the anal mucsa first followed by IAS and then EAS and then stitch the rest with the normal order ⇒ 1 cm abive vagina apex = vagina mcosa = mcle layer then etc