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Primary Surgery Vol.1 – Non-Trauma |  |
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Primary Surgery Vol.1 – Non-Trauma | |
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If a patient with obstructed labour is admitted from home, she may have been in labour for days, and tried many home remedies. Her stomach is likely to be full, and she can inhale its contents only too easily. She is thus a major anaesthestic risk. There are several ways in which you can deliver her, but the standard midcavity or rotational forceps, such as Kielland’s, should never be one of them (18.1).
is often possible, but try to avoid a difficult one. Learn to predict when it is going to be difficult, so that you can avoid a ’failed vacuum’, and do a Caesarean section or a symphysiotomy (18.6, M 22.7) to begin with, especially when there is fetal distress. An operative vaginal delivery is absolutely contraindicated if her uterus has already ruptured—do a laparotomy. Often, you will not know if it has ruptured or not, so do all vaginal operations for the relief of obstructed labour in the theatre, with a set of laparotomy instruments ready for instant use.
has a limited role, and is likely to be a serious risk, so don’t do it lightly. It is mainly indicated: (1) when a baby is alive and his mother is in reasonable condition. (2) When a destructive operation on a dead baby would be dangerous, because his head is mobile 3/5, or more, high above her pelvic brim (rare). Try not to section her, if she cannot be sure of adequate care in her next delivery, or if your skills and facilities for doing so safely are not good. If you have to section her, Section 18.8 will help you to decide on the most suitable method.
(M 22.10) is indicated when her baby is dead, her cervix is fully dilated or nearly so, the presenting part is fixed in her pelvis, and her uterus has not ruptured, and is in no danger of doing so. Usually, you can be fairly sure that a uterus is not going to rupture. If you are in any doubt, the only way to find out is to do a laparotomy, and see if there is a rupture. If you don’t find one, close her abdomen and deliver her vaginally.
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Primary Surgery Vol.1 – Non-Trauma | |
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