vaginal vaginal delivery

Transabdominal vaginal incision is the process of not cutting the uterus after laparotomy but cutting the vagina to deliver the baby. In 1906, Joery first proposed this method for cesarean section to avoid cutting the uterus. In 1978, Garrigues cut the vagina from the outside of the cervix and removed the fetus from the open cervix. However, this method may damage the ureter and bladder, so the bladder should be pushed away from the surgery. In addition, this method is also prone to infection, and once the vaginal incision is torn, suturing is more difficult. If the healing is not good, it will form a more obvious scar, which may affect sexual life and re-delivery. Therefore, this method is rarely used. However, since the 1970s, a small number of cases have been reported and the results have been good. Treating diseases: dystocia Indication Transabdominal vaginal incision is only suitable for the second stage of labor. The position of the fetal head is high. If the delivery from the vagina is necessary, it is necessary to use the middle or high position forceps, which will cause great danger to the baby. Absolute indications. But the cervix must be open and fully retracted, otherwise the incision will be on the cervix. Preoperative preparation 1. The timing of surgery Whether the timing of surgery is appropriate or not is directly related to the safety of mothers and infants. According to statistics, the rate of emergency surgery mother and infant is 2 to 3 times higher than that of elective surgery. Therefore, emergency surgery should be reduced as much as possible. In general, after the full-term pregnancy, the lower part of the uterus has formed, the uterine part is enlarged, the maternal still does not feel tired, and the fetus has no signs of hypoxia, which is the best time for surgery. 2. Preoperative preparation for elective surgery 1 Advance admission is required. There are clear indications for surgery during antenatal examination, or women who are likely to undergo surgery should be admitted before the expected date of delivery. 2 active treatment of complications, for those with complications, should be actively treated first, such as pregnancy-induced hypertension syndrome, should be treated when the treatment is not yet fully control when choosing a favorable time for surgery. Pregnant women with anemia should check the cause and correct anemia. Pregnant women with heart disease should have heart failure before heart failure. Active infection prevention, etc., when co-infection. 3 Actively promote the maturity of the fetus, and promote the fetal lung maturation in time if the fetus is immature and must be delivered. The elective surgery can be done under all preparations, after the start of labor, or at the time of pre-production. 3. Emergency surgery preparation Most of the emergency operations have encountered difficulties in the labor process, or the pregnancy has to be terminated immediately due to sudden changes in pregnancy complications. Some of them have been treated earlier because of admission. If you are admitted to the emergency department, the doctor should pay close attention to review the medical history, do a physical examination and necessary auxiliary examinations, fully estimate the mother and baby, and identify the surgical indications. 4. Specific preparations 1 Correct the general condition, according to different conditions to deal with, especially pay attention to correct maternal dehydration, electrolyte imbalance, and actively deal with fetal distress. If there is hemorrhagic shock, the blood volume should be supplemented in time. 2 blood preparation, obstetric hemorrhage is often very urgent and large, you should always be ready for blood transfusion. Those who have had bleeding before delivery should be operated at the same time as blood transfusion. Because of the need for surgery before the bleeding, they can effectively stop bleeding, so they can not wait for a long time and delay the rescue. 3 preparation of skin, according to the scope of gynecological abdominal surgery. 4 catheter. 5 Preoperative medication, for pregnant women with infection or possible infection, antibiotics should be given before surgery. For immature fetuses. Preoperative medication to promote fetal lung maturation. 6 to prepare for the rescue of infants, including tracheal intubation, umbilical vascular injection. It is best to have a neonatologist to participate in the rescue. Surgical procedure 1. Abdominal wall incision The same as the cesarean section of the lower uterus. 2. Incision of the bladder, peritoneal reflex Pushing the bladder down is similar to the cesarean section of the lower uterus, but the range of the pushdown bladder is wider and the lower boundary is deeper. 3. Expose the vaginal Use the pubic retractor to completely retract the bladder downwards, correctly understand the boundary between the lower part of the uterus and the upper part of the vagina, and reveal at least 4 cm above the anterior wall of the vagina. It can be seen that the vaginal wall is swollen with a ball and the surface has a special luster, which is the part of the incision. 4. Cut the vagina, deliver the fetus, placenta In the middle of the above part of the vaginal wall, a small opening is cut transversely, and the surgeon extends under the guidance of the finger to extend the incision to the sides with a blunt scissors, the length of which can be delivered to the fetal head. Generally, the single-leaf forceps are used to pull the fetal head up in front of the fetal head, and the fetal head can also be pulled out by the double-leaf forceps. The placenta is delivered after waiting for natural peeling. The vaginal margin is clamped and lifted with Alice's jaw. 5. Stitching the vagina and pelvic peritoneum Use the No. 1 chrome gut to break the vaginal wall and prevent the incision from bleeding. The bladder dissection surface was completely hemostasis after hemostasis, and the peritoneal reflex was continuously sutured with a thin thread or a 0-chrome gut. 6. Suture the abdominal wall Same as the lower uterus cesarean section. complication 1. Bladder injury. 2. The vaginal incision is torn or combined with infection, and a scar is formed upon healing to cause vaginal stenosis.

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