SUMMARY OF SOME IMPORTANT CASES OF OBSTETRICS

(Clinical features, Investigations, Treatment, Complications & Others)

1st stage of Labor

Diagnosis of onset of labor- General Management- Obstetric Management- Complications-
- Painful uterine contraction at regular intervals - The patient should be kept under close (i) Fetal Monitoring: Fetal heart rate should be recorded at ½ - Prolong 1st stage of labor
- Progressive dilatation and effacement of cervix supervision with physical & mental support. hourly intervals in between contractions at least for 60 seconds - Fetal distress
- Bulging of fore water during pain - Adequate nutrition is to be maintained and recorded in Partograph. - Early rupture of membrane with or
- Presence of show - Frequent voiding of urine to keep bladder empty (ii) Maternal monitoring: Pulse, BP, Temperature, Dehydration, without cord prolapse
Clinical course of 1st stage of labor- - Enema may be given to empty the bowel Urine output, fluid intake should be recorded regularly. - Hypotonic or incoordinate uterine
- Labor pain - She may be ambulant or take rest in left lateral (iii) Progress of labor: contraction
- Dilatation and effacement of the cervix position - A/E: Uterine contraction, Descent of the head in fifths - Cervical dystocia
- Status of membrane: intact - Inj. Pethidine 75mg & Inj. Phenergan 25 mg IM - V/E: Not done frequently. This examination should note
should be given when she is in active labor degree of dilatation, effacement of cervix, status of membrane,
presenting parts & its position, assessment of pelvis.
2nd stage of Labor
Clinical course of 2nd stage of labor- General Measures- Preparation for delivery- Conduction of delivery:
- Pain - The patient should be in bed. - Position: Dorsal position with 15 left lateral tilt - Delivery of the head
- Bearing down efforts - Constant supervision is mandatory. - The accoucheur scrubs up and puts on sterile gown, mask and - Delivery of the shoulder
- Membrane status - FHR is recorded at every five minutes. gloves and stands on the right side of the table. - Delivery of the trunk
- Descent of the fetus - Administration of analgesics - Toileting the external genitalia and inner side of the thighs Complications:
Operative procedures undertaken in 2nd stage: - V/E is done to confirm the onset of 2nd stage - Essential aseptic procedures: Clean hands, Clean surface, * Delayed 2nd stage labor
Episiotomy, Caesarean section, Forceps delivery, Clean cutting & ligaturing of cord * Fetal distress, * Cord prolapse
Ventouse delivery, Destructive operation - Catheterization: If bladder is full * Shoulder dystocia, * Air embolism
3rd stage of Labor
Events/Criteria of 3rd stage of labor- Active management of 3rd stage labor (AMTSL) Advantages of AMTSL: Complications-
rd th
- Placental separation - Inj. Oxytocin 10IU I/M is given within 1 min of - To minimize blood loss in 3 stage approximately 1/5 - Postpartum Hemorrhage (PPH)
- Descent of placenta of the lower segment delivery of the baby. - To shorten the duration of 3rd stage of half - Retained placenta
- Expulsion of the placenta with the membranes - The placenta is to be delivered by controlled - To prevent PPH, - Reduces maternal anemia - Uterine inversion
cord traction (CCT) & counter traction. Disadvantages of AMTSL: - Obstetrical shock
- Immediate massage the fundus of uterus through - Slight increased incidence of retained placenta - Air embolism
abdomen until the uterus is contracted. - Accidental administration during 1st baby in undiagnosed twin
produces grave dangers to the unborn 2nd baby due to asphyxia
Puerperal Pyrexia
Symptoms- Investigations- Treatment:
Fever, Abdominal pain, Offensive vaginal discharge - High vaginal/endocervical swab for C/S (i) General: Isolation of patient, Adequate fluid & calorie by IV fluid, Anemia correction, Maintain
Signs- - Urine R/M/E and C/S - CBC with ESR intake & output chart
- G/E: Anemia, pulse, temperature, dehydration - Blood culture - USG of abdomen with pelvis (ii) Antibiotics: Mild- Cap. Amoxicillin or Ampicillin 500mg
- A/E: Height & involution of uterus, Peritonitis - Thick blood film for malarial parasites Severe- Inj. Ampicillin 500mg IV + Inj. Metronidazole 500mg IV + Inj. Gentamicin 80mg IV
- I/E: Amount, color of lochial discharge, DRE to - CXR (iii) Dressing & cleaning of the wound, if any puerperal sepsis
exclude pelvic abscess - Blood urea & electrolytes (iv) Antipyretics
 Puerperal Sepsis
Clinical features- Investigations- Treatment: Predisposing Factors-
(i) Local infection: Fever, Malaise or headache - High vaginal/endocervical swab for C/S - General: Isolation of patient, Adequate fluid & calorie by IV - Antepartum: Malnutrition &
(ii) Uterine infection: Rise of temp, rapid pulse, - Urine R/M/E and C/S fluid, anemia correction, Catheterization, Monitoring vital signs Anemia; Preterm labor; PROM;
uterus sub involuted & tender, Lochia scanty - CBC with ESR - Antibiotics: Inj. Ceftriaxone or HIV, Diabetes, Prolong rupture of
(iii) Spreading: Pelvic peritonitis, pelvic abscess- Blood culture Inj. Gentamicin and Inj. Clindamycin; Inj. Metronidazole membrane
- USG of abdomen with pelvis - Surgical: (i) Evacuation of uterus after antibiotic coverage - Intrapartum: Repeated vaginal
- Thick blood film for malarial parasites (ii) Colpotomy- for pelvic abscess drainage examination; Dehydration &
- CXR (iii) Laparotomy (iv) Hysterectomy (v) Removal of stitches ketoacidosis, Hemorrhage, Prolong
- Blood urea & electrolytes (vi) Management of septic shock & obstructed labor; C/S delivery
Multiple Pregnancy
History- Investigations- Delivery of 1st baby: Complications-
- H/O ovulation inducing drug USG of uterus for pregnancy profile - As the baby is usually small, the delivery does not usually Maternal: (A) During pregnancy-
- Family H/O twinning Treatment- pose any problem (i) Hyperemesis gravidarum
Symptoms- Antenatal Management: - Extended episiotomy under local infiltration e- 1% lignocaine (ii) Anemia (iii) Pre-eclampsia
- Increased nausea & vomiting (i) Diet: Increased dietary supplement - Forceps delivery under pudendal block anesthesia in needed (iv) Hydramnions (v) APH
- Cardio-respiratory embarrassment (ii) Rest: Increased rest at home & early cessation - Not to give IV ergometrine with the delivery of the 1st baby (vi) Preterm labor
- Swelling of legs, varicose veins & hemorrhoids of work - Clamp the cord at two places and cut in between. (B) During Labor-
- Excessive fatal movement (iii) Supplement therapy: - Baby is handed over to the nurse after labeling as number 1. (i) Early rupture of membranes
nd
Signs- - Iron therapy Delivery of 2 twin: (ii) Cord prolapse (iii) Prolong labor
- G/E: anemia, unusual weight gain, pre-eclampsia - Additional vitamin, calcium & folic acid - In longitudinal lie: Artificial rupture of membrane is to be (iv) Intrapartum hemorrhage
- A/E: - More frequent antenatal visit done & if within 5 mins contraction doesn’t appear, then 5 units (C) During puerperium-
Inspection: Uterus is changed to barrel shape - Fetal surveillance is maintained by serial USG at of Oxytocin in 500cc of 5% dextrose should be started. (i) Subinvolution (ii) PPH
Palpation: Height of uterus more than period of every 3-4 weeks interval - In vertex presentation: If head is low down- Forceps/Ventouse (iii) Puerperal sepsis
amenorrhea, palpation of too many fatal parts - Patient should be hospitalized at any time when delivery & If high up- breech extraction under anesthesia. Fetal: (i) Abortion, (ii) Asphyxia,
Auscultation: Two distinct FHS located at complication develops. - In Breech presentation: Breech extraction (iii) Prematurity, (iv) Still birth
separated spots. - In transverse lie: Internal podalic version & breech extraction (v) IUD of 1 fetus (vi) Locked twin
Pre-Eclampsia
Symptoms- Investigations- Treatment- Complications-
(A) Mild: (i) Slight swelling over the ankles - Urine R/M/E and bed side General management: Obstetric management: (A) Immediate-
(ii) Tightness of the ring in the finger urinary protein - Hospitalization (i) If BP becomes controlled, edema Maternal: (i) Eclampsia,
(iii) Gradually swelling extend to whole body - 24 hours Urinary protein - Bed rest in lateral position subsides, proteinuria insignificant & (ii) Preterm labor, (iii) PPH
(B) Alarming: (i) Headache (ii) Disrupted sleep - Serum uric acid - Diet: adequate amount of daily protein, good fetal condition- Pregnancy can be (iv) Shock, (v) P. Sepsis
(iii) Diminished urine output (iv) Epigastric pain - Serum creatinine usual salt intake continued till 39-40 weeks & then Fetal: (i) IUD (ii) Asphyxia
Signs- - Platelet count - Drugs- Methyl-dopa, Nifedipine, Labetalol termination. (iii) IUGR (iv) Prematurity
(i) Abnormal weight gain (ii) Rise of BP - Coagulation profile In hypertensive crisis: Nifedipine, Na- (ii) If BP persists- General management (B) Remote-
(iii) Edema- visible edema over the ankles - Hepatic enzyme (SGPT, SGOT) nitroprusside I/V is to be continued (i) Residual hypertension
(iv) P. edema (v) No chronic CVS/renal pathology - USG of uterus for pregnancy - Sedative: Tab. Diazepam 5mg (iii) If BP is uncontrolled, proteinuria (ii) Recurrent pre-eclampsia
(vi) A/E: Evidences of placental insufficiency profile - Maternal & fetal monitoring significant and early signs symptoms of (iii) Chronic renal disease
- Ophthalmoscopy - Prophylactic MgSO4 is started when SBP impending eclampsia- Termination of (iv) Placental abruption
- NST & Biophysical profile >>>> 160mmHg and DBP >>> 100mmHg pregnancy irrespective of gestational age
 Eclampsia
Presented with- Management:
Convulsion, High BP, Coma, Edema (A) General Management: (B) Control of Convulsion (E) Obstetrical management:
Principles of management: (i) Maintain eclamptic position (ii) Airway clear - By anti-convulsant drugs - Termination of pregnancy irrespective
(i) General management (iii) O2 inhalation (iv) IV fluid (v) Catheterization - MgSO4 is drug of choice of gestational age.
(ii) Control of convulsions (vi) Prophylactic antibiotic (Ceftriaxone 1gm IV) - If MgSO4 is not available/contraindicated, Diazepam
Complications-
(iii) Control of HTN (vii) Change of posture 2 hourly (viii) Care of eye should be used.
Maternal: P. edema, Pneumonia, ALVF,
(iv) Treatment of complications (ix) Maintain oral hygiene (C) Control of Hypertension
RF, Hyperpyrexia, Neurological deficit,
(v) Obstetrical management (x) Short history is to be taken regarding number of - By anti-hypertensive drug
Disturbed vision, Thrombocytopenia,
fits, parity, gestational age, any medication. - Commonly used: Labetalol, Nifedipine, Methyl dopa
Shock, Sepsis, Psychosis
(xi) Blood is to be drawn and sent for routine inv. (D) Treatment of complications-
Fetal: Prematurity, IUGR, IUD, Trauma
(x) A quick but thorough general, abdominal and (i) Resp.: by antibiotic (ii) P. edema: Frusemide
during operative delivery, Effect of drug
vaginal examination are made (iii) HF: O2 inhalation (iv) Hyperpyrexia: Anti-pyretic
Placenta Previa
Symptoms- Investigations- Treatment- Complications-
Sudden onset, painless, apparently causeless and - USG of uterus for pregnancy profile (Confirmatory) (A) Expectant- Maternal: APH with shock, Premature
recurrent vaginal bleeding - CBC with ESR (i) Hospitalization (ii) Bed rest (iii) Wide bore IV canula labor, Malpresentation, Early rupture of
Signs- - Blood grouping & Rh typing (iv) IV fluid (v) Blood transfusion (vi) Iron & folic acid membrane, Cord prolapse, PPH,
(i) G/E- Anemia - Blood glucose level (vii) Catheterization (viii) Close follow up- vaginal Retained placenta, P. sepsis, Embolism
(ii) A/E- Soft, relaxed, elastic uterus. Breech or bleeding, fetal movement, Pulse-BP, FHR, Uterus height Fetal: LBW, Fetal growth retardation,
transverse or unstable lie is frequent, FHS present (B) Definitive- Asphyxia, IUD, Birth injuries,
(iii) Vulval inspection- characteristic of blood - Type I & II anterior: NVD Congenital malformation
- Type II posterior, III & IV: Caesarean section
Abruptio Placenta
Symptoms- Investigations- Treatment- Complications-
Severe abdominal pain, Vaginal bleeding - USG of uterus for pregnancy profile (A) General: Maternal:
Signs- - CBC with ESR (i) Immediate hospitalization (ii) Resuscitation IV fluid Hemorrhage, Shock, Blood coagulation
(i) Uterus Ht: Proportionate to period of gestation - Blood grouping & Rh typing (iii) Blood drawn for blood grouping & coagulation test disorders, Oliguria & anuria, PPH,
(revealed), disproportionately enlarged (mixed) - Coagulation test: CT, platelet count, APTT, FDP (iv) Blood transfusion (v) Catheterization (vi) Close Puerperal sepsis
(ii) Fetal part can be identified easily in revealed - Urine for protein follow-up Fetal:
type and difficult to identify in mixed type (B) Definitive: Immediate termination of pregnancy Prematurity, Hypoxia
(iii) FHS- present (revealed), absent (mixed) irrespective of gestational age.
Primary Postpartum Hemorrhage
Symptoms- Investigations- Treatment- Causes-
Bleeding per vagina with or without visible blood - CBC with ESR - Shout for help and assess ABC & resuscitation (1) Atonic: Grand multipara, Over
clot within 24 hours following birth of the baby - Blood grouping & Rh typing - Massage fundus to expel blood clot - 10IU Oxytocin IM distension of uterus, Malnutrition,
Signs- - Coagulation profile (BT, CT, PT) - IV fluid access with wide bore canula Anemia, APH, Anesthesia, Fibroid uterus,
G/E- Anemia, Features of shock - USG for any retained bits of placenta - Catheterization, Initiate & encourage breast feeding Precipitate labor
A/E- Uterus is flabby & hard in atonic cases - Assess pulse, BP & monitor blood loss, urine output (2) Traumatic: Laceration of cervix,
V/E- Bleeding copious, clotted blood may be seen - Inj. Ergometrine 0.2mg IM, Tab. Misoprostol 800μgm PR vagina, Uterine rupture, Uterine inversion
- Blood transfusion (3) Retained tissues: Bits of placenta
- Reassure the mother and keep the family informed. (4) ITP, Hemophilia A, VWD
 Retained Placenta
History- Investigations- Treatment-
(i) H/O delivery (ii) Placenta is not expelled out - CBC with ESR (A) General Treatment: (i) Rapid assessment of the patient (pulse, BP, temperature, PV bleeding)
even 30 minutes after the birth of the baby - Blood grouping & Rh typing (ii) IV fluid started (iii) Catheterization (iv) Blood transfusion
Symptoms- - RBS (B) Specific treatment:
PV bleeding (i) Placenta is separated and retained: to express the placenta out by controlled cord traction
Signs- (ii) Unseparated retained placenta: Manual removal of placenta under GA
G/E- Anemia, Features of shock (iii) With shock but no hemorrhage: Treatment of shock, Manual removal of placenta under GA
A/E- Uterus soft & flabby (iv) With hemorrhage: Management of 3rd stage hemorrhage
V/E- Placenta is not felt in vagina & cervix (v) With sepsis: Swab for C/S and BS antibiotic, Manual removal of placenta under GA
(vi) Morbid adhesion of placenta: Hysterectomy
Gestational Diabetes Mellitus
History- Investigations- Treatment- Complications-
- Short family H/O T2 DM - CBC with ESR - ANC regularly - Diet: Diabetic diet Maternal: Spontaneous abortion, UTI,
- Previous H/O Gestational Diabetes - Blood grouping & Rh typing - Frequent monitoring of blood glucose level by glucometer Preterm labor, Polyhydramnios, PPH,
- Birth of large baby having weight of >4kg - Urine R/M/E - Use of insulin: indicated when post prandial sugar level is Maternal distress, Prolonged labor,
- Maternal age more than 35 years - Fasting blood sugar & 2 hours post prandial sugar >140 mg/100 ml even on diet control Puerperal sepsis, Lactation failure
Clinical features- - OGTT and HBA1C - Maternal & fetal monitoring Fetal: Fetal macrosomia, Congenital
- F/O established diabetes: Polyuria, Polydipsia - USG of uterus for pregnancy profile - Obstetric management: malformation, Birth injuries, IUGR,
- Marked obesity - Evidence of vasculopathy - Biophysical profile for fetal well being Women requiring insulin or with complications- Elective IUD, Neonatal complications (RDS,
- F/O toxemia delivery induction or C/S at around 38 weeks Hypoglycemia), Childhood obesity.
Premature Rupture of Membranes (PROM)
Symptoms- Sudden gush of fluid per vagina or Investigations- Treatment-
watery vaginal discharge (i) CBC with ESR (ii) Urine R/M/E & C/S (A) General: Hospitalization, Bed rest, Wearing of clean vulval pad, BS antibiotic, Counseling of
Signs- (i) Maternal temperature & pulse, (ii) FHR (iii) Endocervical swab: G/S & Culture mother, Maternal & fetal monitoring
(iii) P/A- reduced size of uterus than gestation (iv) USG (v) CTG (vi) Nitrazine test (vii) Fern test (B) Obstetrical: (i) PROM e- Chorioamnionitis: Termination of pregnancy by induction of labor with
(iv) S/E- odor of discharge, exclude cord prolapse (viii) Nile blue sulphate test Oxytocin or Caesarean section
Causes- (i) Increased friability of the membrane Complications- (ii) Term PROM without Chorioamnionitis: Induction of labor with oxytocin or LUCS
(ii) Decreased tensile strength of the membranes Maternal: Preterm labor, Infection, Cord prolapse, (iii) Pre-term without Chorioamnionitis:
(iii) Polyhydramnios (iv) Cervical incompetence Dry labor, Placental abruption - Gestational age 34-37 weeks: Induction of labor by oxytocin or LUCS
(v) Infection (vi) Multiple pregnancy Fetal: Prematurity, Fetal pulmonary hypoplasia, - Gestational age 24-34 weeks: Corticosteroids, Tocolytics
(vii) Prior preterm labor (viii) Low BMI Neonatal sepsis, RDS, IVH, NEC in pre-term PROM - Gestational age <24 weeks: Active termination of pregnancy
Post-term Pregnancy
History- Investigations- Treatment- Complications-
Correct LMP, Menstrual cycle, No recent H/O USG of uterus for pregnancy profile Termination of pregnancy Fetal: Diminished placental function,
hormonal contraception, Previous antenatal record (A) Uncomplicated group: Induction of labor Oligohydramnios, Hypoxia & acidosis,
Signs- Causes- - If cervix is favorable (ripe): by low rupture of the Shoulder dystocia, Cord compression,
A/E- Height of uterus, Girth of the abdomen (i) Due to inaccurate LMP, (ii) Hereditary membranes or stripping of membrane Hypoglycemia, Polycythemia.
V/E- Cervix usually ripe, feeling of hard skull (iii) Maternal factors: Primiparity, Sedentary habit - If cervix is unfavorable (unripe): Vaginal administration Maternal: Increased maternal
bones either through cervix or fornix (iv) Fetal factors: Anencephaly of PGE2, Oxytocin infusion when required morbidity, Hazards of induction od
(v) Placental factors: Low estrogen (B) Complicated group: Elective caesarean section labor
 Intrauterine Fetal Death
Symptoms- Investigations- Treatment- Complications-
Absence of fetal movements - USG of the uterus for pregnancy profile (A) Expectant: Spontaneous expulsion occurs within 2 wks - Psychological upset
Signs- - Plain X-ray abdomen (B) Active: Induction of labor by- - Infection
G/E- Retrogression of the positive breast change - Blood fibrinogen level - Oxytocin (in favorable cervix) - DIC
A/E- Gradual retrogression of the fundal height, - Hematological: Blood grouping & Rh typing, - Prostaglandin intracervical gel or vaginal tablet - Retained placenta
Uterine tone diminished, FHS absent, CTG- flate Blood sugar, HbA1C, VDRL, S. creatinine, TORCH - PPH
Fetal Distress
Clinical features- Investigations- Treatment- Causes-
- Alternation of fetal heart rate - Doppler ultrasound blood flow study - The patient should be turned on her left side. (A) Acute fetal distress-
- Progressive increase of caput formation - Fetal ECG - Oxytocin infusion should be stopped immediately - Abruptio placenta
- Meconium staining of the liquor in cephalic - Fetal scalp blood sampling - V/E is done to exclude cord prolapse & color of liquor - Rupture uterus
- Fetal pulse oximetry - Adequate hydration is to be maintained - Cord prolapse
- Oxygen is to be given by nasal catheter at 5-6 L/min rate (B) Chronic fetal distress-
- Delivery: 1st stage of labor: Caesarean section - Chronic placental insufficiency
2nd stage of labor: Forceps or ventouse delivery - IUGR
Deep Transverse Arrest
By Vaginal Examination- Causes- Treatment- Complications-
- The head is engaged - Faulty pelvic architecture (A) Pelvis Adequate: Maternal: Prolonged labor, Obstructed
- The sagittal suture lies in the transverse - Deflexion of the head - Ventouse (ideal) labor, Rupture uterus, Shock
bispinous diameter - Weak uterine contraction - Manual rotation & forceps application Fetal: Fetal asphyxia, IUD
- Anterior fontanelle is palpable - Laxity of the pelvic floor muscle - Forceps rotation & delivery
- Faulty pelvic architecture may be detected. (B) Pelvic inadequate: Caesarean section
Breech Presentation
Diagnosis is done after 32 weeks of gestation. Investigations- Treatment- (C) Management during labor-
P/A examination- - USG of uterus for pregnancy profile (A) Antenatal Management: (1) Management is 1st stage of labor-
-Fundal grip: hard, round, well circumscribed head - Plain X-ray Abdomen - Identification of the complicating factors (i) Bed rest
-Lateral grip: Fetal back is to one side - External cephalic version (ii) Adequate nutrition
-First pelvic grip: Broader, softer, irregular fetal part Complications- - Formulation of the line of management: Elective C/S or (iii) Vaginal examination
P/V examination- Fetal: Birth Asphyxia, Intracranial hemorrhage, vaginal breech delivery. (iv) Adequate analgesia
-During pregnancy, soft & irregular parts are felt. Hematoma, Fracture to cervical spine, femur etc., (B) Mode of delivery: (v) Monitoring fetal status
-During labor, breech can be diagnose accurately, Soft tissue injury, Stretching of brachial plexus. - If patient primi: Elective C/S after counselling (vi) Oxytocin infusion
when the cervix is at least 3-4cm dilated & the Maternal: Vaginal laceration, Cervical tear, - If patient parous, good obstetric history without (vi) Patient should be sedated
membrane is ruptured. Puerperal Sepsis, Increased operative delivery. complicating factors: Vaginal delivery (2) Management in 2nd stage of labor-
- If patient associated with PET, diabetes, previous C/S & (i) Spontaneous
bad obstetric history: C/S (ii) Assisted breech
- In case of a primi with a fairly adequate pelvis, favorable (iii) Breech extraction
cervix, average fetal size without associated complicating (3) Active management of 3rd stage of
factors: Spontaneous vaginal delivery labor
 Transverse Lie
P/A examination- Investigations- Treatment: ii) Obstetrical Management-
- Height of the uterus: Less than gestational age - USG of uterus for pregnancy profile (A) Antenatal management: - If pregnancy full term & fetus alive: C/S
- Fundal grip: Fetal pole - Plain X-ray Abdomen - Frequent Repeated antenatal check up - If the fetus dead, cervix is full dilated,
- Lateral grip: Soft, broad & irregular breech - Repeat USG at 36-38 weeks shoulder is not impacted: Breech extraction can
- Pelvic grip: Lower pole of the uterus found empty Complications- - External cephalic version may be tried beyond 35 weeks be tried under GA
- Auscultation: FHS will be heard at a higher level Maternal: Obstructed labor, Rupture uterus, (B) Management during labor: - In neglected obstructed tumor: Resuscitation
P/V examination- Hemorrhage, Shock, Septicemia, Maternal i) General Management- & C/S
- During pregnancy: Presenting part cannot be death - IV fluid should be started at once - In term pregnancy with hand prolapse: C/S
identified properly but one can feel some soft part Fetal: Early rupture of the membrane, Cord - Blood is sent for grouping, Rh typing & cross matching - In rupture uterus: Resuscitation and
- During labor: Elongated bag of the membrane prolapse, Hand prolapse, Fetal death - Parental antibiotics i.e. Ampicillin 1gm, Cloxacillin 1gm laparotomy followed by repair of the tear or
can be felt. On occasion, the arm found prolapsed. & Metronidazole 500mg should be started hysterectomy.
Obstructed Labor
History- Investigations- Treatment- Complications-
Age & parity of the patient, H/O labor pain, - CBC with ESR (A) General Management: Maternal:
Previous H/O difficult labor - Blood grouping & Rh typing (i) Nothing by mouth, (ii) IV fluid, (iii) Catheterization, (i) Exhaustion (ii) Dehydration (iii) Genital
Examinations- - RBS (iv) Paretal antibiotics (v) Analgesic (Inj. Pethidine) sepsis (iv) Metabolic acidosis (v) Genito-
G/A- Anemia, Temperature, Pulse, BP, Height Causes- (vi) Blood is sent for grouping, Rh typing & cross urinary fistula (vi) Vaginal atresia
A/E- Uterus is contracted & tendered, Distension (i) Fault in passage: Contracted pelvis, matching (vii) Fluid intake & urine output should be noted Fetal:
of bladder, FHS may be irregular, rapid or absent Cervical dystocia, Impacted ovarian tumor (B) Obstetrical Management: (i) Asphyxia (ii) Acidosis (iii) Intracranial
V/E- Vulva edematous, Dry & hot vagina, Cervix (ii) Fault in passenger: Transverse lie, Brow (i) C/S (preferable): Alive fetus, Malpresentation, Fetal hemorrhage (iv) Infection
fully dilated, Membrane ruptured presentation, Big baby, Locked twin distress, Big baby; (ii) Vaginal delivery: Hydrocephalic
Rupture Uterus
History – Causes- Treatment-
Prolonged labor, Varying degrees of vaginal bleeding, Injudicious use of - Obstructed labor Resuscitation followed by Laparotomy
oxytocin - Grand multipara (i) Resuscitation
Examinations- - Injudicious use of oxytocic drugs - IV fluid
G/A- Extreme pallor, Tachycardia, Hypotension, Dehydration, Cold - Internal podalic version - Blood is sent for grouping, Rh typing & cross matching
extremities - Instrumental delivery - Parental antibiotic
A/E- Tense, tender, distended abdomen, Fetal parts are easily palpable, Loss of - Scar rupture (ii) Laparotomy
uterine contour, FHS absent, Retracted uterus felt as a firm mass - Concealed accidental hemorrhage - Hysterectomy: Undoubtedly the best treatment
V/E- Dry, hot, edematous vagina, presenting part jammed in the pelvic cavity. - Repair of the rupture - Repair of the rupture with sterilization
Anencephaly
Diagnosis- Complications- Treatment:
st
In 1 half of pregnancy: USG (confirmatory) (i) Hydramnios (ii) Tendency to post-maturity - If confirmed before 20 weeks: Counselling & termination of pregnancy
In 2nd half: Inability to locate fetal head. USG may help which is confirmatory (iii) Malpresentation (iv) Shoulder dystocia - If confirmed late pregnancy: Counselling & termination of pregnancy,
(v) APH (vi) Obstructed labor PGE2 has proved effective, Shoulder dystocia managed by cleidotomy.

Prepared By-
PARTHA SAROTHI SINGHA
AMUMC-7