Obstetrics and gynecology. Childbirth with loss of small parts of the fetus, large fetus, fetal hydrocephalus (the most important)

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Obstetrics and gynecology. Childbirth with loss of small parts of the fetus, large fetus, fetal hydrocephalus (the most important)

Lecture notes, cheat sheets

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21. Childbirth with prolapse of small parts of the fetus, large fetus, fetal hydrocephalus

Presentation and prolapse of the fetal leg. Complications are observed extremely rarely with cephalic presentation, for example with a premature and macerated fetus, as well as with twins, if there is a sharp flexion of the fetal trunk with an extended leg. If it is impossible to straighten the leg with a viable fetus, a cesarean section is indicated.

Birth of a large and gigantic fetus. Childbirth with malformations and diseases of the fetus. A fruit weighing from 4000 to 5000 g is considered large, 5000 g or more is considered gigantic. With a large and giant fetus, the circumference of the mother’s abdomen is more than 100 cm, the height of the uterine fundus is more than 38 cm, and the fetal head exceeds normal dimensions. Even with the normal course of labor, complications very often arise with a large and giant fetus: primary and secondary weakness of labor, premature and early rupture of amniotic fluid, increased duration of labor. Upon the onset of labor, it may be discovered that the sizes of the pelvis and the fetal head do not correspond to each other. Often the birth of shoulders is difficult. Injuries to the mother and fetus during childbirth, in the afterbirth period, and hypotonic uterine bleeding in the early postpartum period are common. In order to prevent weak labor during childbirth, the creation of an estrogen-glucose-vitamin background is indicated. If measures aimed at enhancing labor with the development of labor weakness are not effective, a cesarean section is performed. It is necessary to stop inducing labor and proceed to this operation if there is a discrepancy between the sizes of the pelvis and the fetal head. If there is a threat of rupture of the perineum during the period of expulsion, it is necessary to dissect it. From the beginning of cutting into the fetal head, to prevent uterine bleeding, the woman in labor must be administered oxytocin (5 units) with glucose intravenously or 1 ml of a 0,02% solution of ergometrine maleate. In case of breech presentation of a large and giant fetus, delivery is carried out by cesarean section.

Childbirth with hydrocephalus. Often, fetal hydrocephalus is accompanied by weakness of labor and overextension of the lower uterine segment due to the disproportion between the pelvis and the fetal head. When examining a woman in labor, a large fetal head is palpated. Even with good labor activity, there is no insertion of the head into the small pelvis. Also, a vaginal examination reveals thinning of the skull bones, their mobility, wide sutures and fontanelles. With breech presentations, signs of hydrocephalus are detected only after the birth of the body. Hydrocephalus is detected by ultrasound.

With pronounced signs of fetal hydrocephalus, in cases of impossibility of delivery, fluid is released by puncturing the skull. Carrying out this manipulation is possible only with head presentations.

Author: Ivanov A.I.

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