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Descent of the fetal head

 

Descent assessed by abdominal palpation: Refers to the part of the head (divided into 5 parts) palpable above the symphysis pubis; recorded as a circle (O) at every vaginal examination. At 0/5, the sinciput (S) is at the level of the symphysis pubis.
 

Episiotomy (Most common obstetrical operation):

 

Should be considered only in the case of:

  1. Complicated vaginal delivery (breech, shoulder dystocia, forceps, vacuum)
  2. Scarring from female genital mutilation or poorly healed third or fourth degree tears;
  3. Fetal distress.
  4. Primi patients

Time

 

Best in vertex – Crowning of head

 

Best in breech – Climbing of perineum

 

TABLE. Advantages and Disadvantages of Different Types of Episiotomy

 

Advantages

Midline

Easy to repair

Batter healing

Smaller amount of blood loss

Less Painful

Mediolateral

Extension to rectum or

Sphincter uncommon

Disadvantages

 

Higher risk of Extension to

rectum

 

Greater amount of blood loss

More Painful

Difficult to repair





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