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OPERATIVE DELIVERY
Komal Imtiaz Roll No. 22 Gynecology
An operative delivery is performed if a spontaneous birth is judged to pose a greater risk to mother or child than an assisted one. Operations are divided into abdominal methods (caesarean section) and vaginal assisted deliveries (forceps delivery and vacuum extraction).
Preparations for operative delivery: * Discuss operative delivery with the woman and her partner (if time is short, at least outline what will happen) * Follow the woman’s wishes—no operative delivery can proceed without her consent even if the doctors think that the baby will die if it is not done * Get written consent for elective procedures * A paediatrician should attend any delivery where problems are anticipated; local guidelines should be drawn up and followed for all operative deliveries
Indications for caesarean section * Cephalo-pelvic disproportion—When it is obvious either antenatally or in the early stages of labour that the fetus, presenting by the head, is not going to pass through the pelvis * Relative cephalopelvic disproportion—The fetus descends initially during labour but is then arrested, possibly due to a malposition such as occipito-posterior * Placenta praevia—Particularly if it is overlapping the internal os * Fetal distress—In the first stage of labour * Prolapsed cord * To avoid fetal hypoxia—When there is poor perfusion of the placental bed (for example, pre-eclampsia) * Malpositions—For example, brow * Malpresentations—For example, transverse lie, breech * Bad obstetric history * Maternal request Caesarean section
Use
The frequency of this operation in Britain has increased from about 5% in 1930 to about 16% now. In a survey of 327 obstetricians by Savage et al in Great Britain in the early 1990s, the main reason reported for this rise (cited by 48% of respondents) was litigation (defensive medicine).
In the United States, where the
Komal Imtiaz Roll No. 22 Gynecology
An operative delivery is performed if a spontaneous birth is judged to pose a greater risk to mother or child than an assisted one. Operations are divided into abdominal methods (caesarean section) and vaginal assisted deliveries (forceps delivery and vacuum extraction).
Preparations for operative delivery: * Discuss operative delivery with the woman and her partner (if time is short, at least outline what will happen) * Follow the woman’s wishes—no operative delivery can proceed without her consent even if the doctors think that the baby will die if it is not done * Get written consent for elective procedures * A paediatrician should attend any delivery where problems are anticipated; local guidelines should be drawn up and followed for all operative deliveries
Indications for caesarean section * Cephalo-pelvic disproportion—When it is obvious either antenatally or in the early stages of labour that the fetus, presenting by the head, is not going to pass through the pelvis * Relative cephalopelvic disproportion—The fetus descends initially during labour but is then arrested, possibly due to a malposition such as occipito-posterior * Placenta praevia—Particularly if it is overlapping the internal os * Fetal distress—In the first stage of labour * Prolapsed cord * To avoid fetal hypoxia—When there is poor perfusion of the placental bed (for example, pre-eclampsia) * Malpositions—For example, brow * Malpresentations—For example, transverse lie, breech * Bad obstetric history * Maternal request Caesarean section
Use
The frequency of this operation in Britain has increased from about 5% in 1930 to about 16% now. In a survey of 327 obstetricians by Savage et al in Great Britain in the early 1990s, the main reason reported for this rise (cited by 48% of respondents) was litigation (defensive medicine).
In the United States, where the