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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



Best in vertex – Crowning of head


Best in breech – Climbing of perineum


TABLE. Advantages and Disadvantages of Different Types of Episiotomy




Easy to repair

Batter healing

Smaller amount of blood loss

Less Painful


Extension to rectum or

Sphincter uncommon



Higher risk of Extension to



Greater amount of blood loss

More Painful

Difficult to repair

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