Tag: extraction on feet

HYDROCEPHALUS

Posted on by The Rebel Surgeon in HYDROCEPHALUS
  • Not an indication for C/S per se
  • Avoid C/S

BREECH PRESENTATION

  • Vaginal delivery
  • Deliver the body
  • Leave body hanging
  • Puncture the head suprapubically with a wide bore needle
  • Drain the cerebrospinal fluid
  • Deliver the collapsed head with Mauriceau-Levret’s maneuver
Suprapubic Puncture of Hydrocephalic Head

CEPHALIC PRESENTATION

  • Puncture the head with a wide bore needle
    • Through the open cervix
    • Suprapubically
      • Technically easier

TRANSVERSE

  • Internal version and extraction on one foot or both feet
  • Deliver as a breech presentation  

AT CESAREAN SECTIO (in case of missed diagnosis)

  • Puncture head and drain cerebrospinal fluid before attempting to extract it through the uterine incision
  • Troublesome vaginal and/or uterine tears may otherwise be the result

Puncture and drainage of the head is not harmful to the child

TRANSVERSE PRESENTATION

Posted on by The Rebel Surgeon in TRANSVERSE PRESENTATION

Transverse presentation is often accompanied by arm prolapse (compound transverse presentation).

  • Compound transverse presentation
    Alive fetus
  • Neglected compound transverse presentation
    Dead fetus

GESTATIONAL AGE < 32 WEEKS / WEIGHT < 1500 GRAM

  • Vaginal delivery

GESTATIONAL AGE > 32 WEEKS / WEIGHT > 1500 GRAM

ALIVE FETUS

  • Cervix closed:
    • Cesarean Sectio

  • Cervix closed and membranes intact:
    • External Version

  • Cervix fully dilated / Membranes ruptured recently / Contractions not very strong:
    • Internal version and extraction using one or both feet
      • Introduce one hand in uterus
      • Search for small parts of the fetus
      • Identify one or both feet
        • Foot has a heal
        • Hand has a thumb
      • Grasp one or both feet with forked fingergrip from behind
      • Apply strong traction on the foot/feet
      • Rotate the fetus with a combination of
        • Traction on foot/feet
        • Upward pressure on caput with other hand on mother’s abdomen
      • Continue strong traction on foot/feet
      • Combined with pumping movements
      • Grasp front of knee with the other hand
      • Extract the upper part of body by a combination of
        • Strong traction
        • Pumping movements
      • Grasp pelvis with both hands
      • Extract upper part of body by a combination of
        • Strong traction
        • Pumping movementsRelease arms
      • Deliver head by Mauriceau-Levret’s maneuver

DEAD FETUS

  • Destructive delivery
    • Decapitation
    • Exvisceration

BETWEEN 32 – 34 WEEKS / 1500 – 2500 gram

Relay on your own judgement