6.

Surgery Obstetrics

I. Induction of Labor
Interests: to save the fetus from the intra-uterine
environment that is dangerous, and or save the mother
in late pregnancy.
Surgical induction method depends on:
The duration of pregnancy
The condition of the cervix (Not good = 0-4, good = 5+)
Fetal head position and shape of the mother's pelvis

METHOD OF DETERMINATION OF CERVICAL SCORE(BISHOP)

Score
Factor
Cervical
Length (cm)
Dilatation
Consistency
Position

Fetal head
Position relative to the
ischial spine (cm)

>4
<1
Solid
Posterior

>2
<2
Average
Middle, anterior

1-2
2-3
Soft
-

<1
>4
-

-3

-2

-1 or 0

+1 or more

Induction of Labor Techniques:

1. Drugs
Prostaglandins
PGE1:terminating the pregnancy age 20 weeks and 30 weeks
PGE2:for cervical ripening when cervical score <5 and is indicated for
amniotomi
PGE2a:to strengthen uterine contractions

Oxytocin: The most commonly used, in 50% of women will birth within
12 hours.More effective if it is preceded PGE 2vaginal or after
amniotomy.

Cont
2. Surgical induction of labor (amniotomy)
It would be more effectively donewhich can arise: the Bishop score> 5
Patients in the lithotomy position Vagina cleaned with antiseptic
liquid doctors two fingers into the vagina one finger into the cervix
to feel the membranes enter the amniotic hooks, membranes solved
very carefully.
Problems that may arise: umbilical cord prolapse (0.5%), infection (if
the time between induction to labor more than 24 hours), bleeding
(usually mild), postpartum hemorrhage, hyperbilirubinemia (duration of
infusion of oxytocin entered after the action amniotomi)

II. Strengthen Delivery

WE can strengthen delivery by:
1. Forceps
2. Vacuum
3. Caesarean section

1. Forceps
a. Indication
Baby Birth delay, the second stage of> 1.5 hours, the fetal head has
seemed diperineum> 30 minutes.
Showing signs of fetal distress, which Brakikardia or discharge of
meconium
Maternal distress (physical, mental)
Maternal diseases (hypertension, heart disease)
Childbirth head in breech presentation

Cont
b. The types of forceps
Forceps short-stemmed (Wrigley) for more low forceps or expenditure
(station +)
Long-stemmed forceps (Simpson) to the middle of the forceps delivery
(station 0)
Kjelland forceps to rotate the fetal head and gave birth

Cont...
c. Techniques delivery with forceps
High or low Forceps(outer)

 Middle Forceps (deep)

2. Caesarean section
a. Indication

Dystocia
Malpresentation / malposition
Antepartum haemorrhage (placental abruption, placenta previa)
Hypertensive disease in pregnancy
Diabetes mellitus
Fetal distress, very low birth weight, iso-immunization
Old primigravida
Failure of labor induction
Repeat Caesarean section