Birth canal injury
•
39 gostaram•19,104 visualizações
Injuries to birth canal are common during childbirth.
Recomendados
Mais conteúdo relacionado
Mais procurados
Mais procurados (20)
Semelhante a Birth canal injury
Semelhante a Birth canal injury (20)
Mais de Devender Kumar
Último
Último (20)
Birth canal injury
- 1. BIRTH CANAL INJURY Devender Maulana Azad Medical College
- 2. Objectives of this Session…. 1. Anatomy of birth canal 2. Classification of injuries 3. Causes, Diagnosis & Management of injuries
- 3. Birth Canal - Definition Genital tract through which delivery of the fetus occurs Uterus Cervix Vagina Vulva (& Perineum)
- 4. Classification of Injury • Depending on anatomical structure involved • Depending on type of injury • Example - Laceration, Hematoma, Rupture
- 5. Anatomical Classification • Injuries to Bony parts • Symphysis pubis • Sacro-coccygeal joint • Sacro-Illiac joint • Injuries to Soft tissue • Vulva • Perineal tears • Laceration to Vagina / Cervix • Rupture of Uterus
- 6. Causes of Injury 1. Incomplete dilation of cervix 2. Instrumentation (Wrong application) 3. Precipitate labor 4. Protracted labor due to borderline CPD 5. Obstructed labor 6. Iatrogenic
- 7. Perineal Injury • Deliberate incision on perineum (Episiotomy) • Perineal tears • Trauma • Bull gore injury • Sexual assault
- 8. Cervical Laceration / Tear • Congenital elongated cervix • Forced dilatation of cervix • Traumatic • During delivery of fetus • Due to instrumentation
- 10. Medio-lateral - Episotomy • Skin • Subcutaneous tissue • Fascia • Superficial and deep transverse perineal muscles • Transverse perineal branches of pudendal vessels & nerve • Bulbospongiosus • Posterior vaginal wall
- 11. Type • Medial • Medio – lateral • Lateral
- 12. Midline Perineum Anatomy • Medial • Vaginal mucosa • Perineal body • Superficial transverse perineal muscles • External anal sphincter • Internal anal sphincter • Anal wall
- 13. First Degree - Perineal tear
- 14. Second Degree - Perineal tear
- 15. Third Degree - Perineal tear
- 17. Vulval Hematomas
- 19. Rupture Uterus • Due to Obstruction in labor • Cephalo-pelvic disproportion • Contracted pelvis • Malpresentation • Fetal malformation • Scarred uterus • Due to Manipulation / Instrumentation • Mis-use of oxytocin
- 22. Bandl’s Ring (Obstruction) • Upper segment contracts & retracts • Upper segment becomes thick • Lower segment Stretches • Lower segment thinning
- 23. Symptoms • Pain • Syncopal attack • Bleeding • Pallor • Tachypnea • Tachycardia • Hypotension • Shock • Signs of obstructed labor • Loss of uterine contour Signs
- 24. Investigations • Hb, PCV, Platelets • Blood group & type • Blood urea • Serum creatinine • Serum Electrolytes • Coagulation profile • Ultrasonography – in cases of doubt
- 25. Informed written consent • Status of the patient • Convey diagnosis & management options • Prognosis • Written consent
- 31. a) 24 hours later b) 48 hours later c) 36 hours later d) Immediately Perineal tears should be repaired
- 32. d) Immediately
- 33. a) Evacuation b) Wait & Observe c) Cold compress d) marsupialisation Most suitable method of treatment of 4 inches size episiotomy haematoma is by
- 34. A ) Evacuation
- 35. a) Immediately b) 2 weeks c) After 6 weeks d) After 12 weeks In a patient with third degree perineal tear, presenting after 72 hr, repair should be done
- 36. d) After 12 weeks
- 37. a) Anal sphincter b) Perineal body c) Perineal muscles d) Rectal mucosa A woman delivers a 4 kg baby with a midline episiotomy and suffers a third degree tear. Inspection shows which of the following structures is intact
- 38. d) Rectal mucosa
- 39. a) Vaginal mucosa b) Urethral mucosa c) Levator ani muscles d) Anal sphincter IIIrd degree perineal tear is involvement of
- 41. a) analgesics b) Ice compress c) Incision and drainage d) Angiographic embolization Which of the following is the best treatment for vulvar hematomas that are extremely painful, but stable in size
- 42. c) Incision and drainage
- 43. Management • Basic life support – A B C D • Correction of shock • Treat anemia & coagulation profile • Treat the cause • Vaginal or cervical Laceration – suture in OT • Paravaginal hematoma – Drain & repair • Supra-levator hematoma or Rupture - Laparotomy
Notas do Editor
- IIA: Internal Iliac Artery; LST: Lumbosacral Trunk; URT: Ureter; EIA: External Iliac Artery; EIV: External Iliac Vein; CT1: Common Trunk 1; UNA: Unnamed Artery; LSA: Lateral Sacral Artery; SGA: Superior Gluteal Artery; CT2: Common Trunk 2; IPA: Internal Pudendal Artery; MRA: Middle Rectal Artery; IVA: Inferior Vesicle Artery; SVA: Superior Vesicle Artery; MUL: Medial Umbilical Ligament; AOA: Abnormal Obturator Artery; AOV: Abnormal Obturator Vein; IEA: Inferior Epigastric Artery; IEV: Inferior Epigastric Vein; UUB: Unusual Branches; UB: Urinary Bladder.