hip delivery

Fetal distress or umbilical cord prolapse; maternal severe comorbidities such as heart failure, immediate termination of delivery and no cesarean section; second productive period of more than two hours without progress. Treatment of diseases: breech dystocia, fetal distress, fetal distress Indication The umbilical cord umbilical cord prolapse or fetal distress; the hip and maternal women have serious complications and should not be excessively forced to hold their breath; the second stage of labor is prolonged; Contraindications 1. Abnormal pelvic or soft birth canal. 2. Foot first exposed. 3. Estimated fetal weight > 4000g. 4.B super sees the fetal head and the extension is a so-called "star-like". 5. B super suggestive umbilical cord first exposed or recessive umbilical cord prolapse. 6. Pregnancy complications or complications such as severe pregnancy-induced hypertension, diabetes, etc. Preoperative preparation Maternal bladder lithotomy, genital disinfection, catheterization. Bilateral pudendal nerve block anesthesia. A maternal puerperal or a perineal tighter woman must have a larger perineal incision. Prepare for resuscitation of neonatal resuscitation. When you are ready, go out and produce the forceps. Before surgery, you must be sure that the headless basin is not called, the palace mouth is full, the fetal hip has been put into the basin, and the type of the breech is checked. If there is a foot in the vaginal opening, the foot must be "blocked" to make the fetus hip, The knee joint is extremely flexed, and the lower limbs are close to the abdomen of the fetus, allowing the hips to fall deeper into the pelvic floor. However, the force should be appropriate, until the birth canal is fully expanded, when the force is lowered in the contraction, the hand has a considerable impulse to assist the midwife; the perineal side incision should be long enough. After the fetal umbilical cord is delivered, the fetal head should be delivered within 8 minutes; if the traction is too fast, the fetal arm can be lifted up, and the rotation and slipping method can be used to assist the shoulder and the upper limb to be delivered; when the delivery is difficult, the assistant can be down on the pubic symphysis. Push the fetal head forward, or use the forceps to assist the delivery; if there is umbilical cord prolapse, but the fetal heart is still good, and there is no immediate condition from the vaginal delivery, cesarean section should be performed immediately; Brain, shoulder and brachial plexus injury and presence or absence of soft birth canal injury. Surgical procedure 1. The occlusion method is mainly used for complete or incomplete breech presentation. The main point is to moderately force the fetal foot to deliver the vagina, make the uterine contraction more reflective, forcing the fetal hip to descend, and the fetal hip and lower limbs are co-extruded at the pelvic floor, which helps the uterine cervix and soft birth canal to fully expand. (1) Blocking the hip: When the lower limb of the fetus is exposed to the vaginal opening, cover the vaginal opening with a disinfectant towel and block it with your hand. Hold the palm of your hand every time you contract, to prevent the fetal foot from coming out early. This repeated contractions can lower the fetal hips and fully expand the vagina until the mother has a strong breath, and when the palm feels quite powerful, she prepares for midwifery. (2) delivery of the buttocks: until the cervix is open, the perineum bulges, the fetal trochanteric diameter has reached the sciatic spine, and when the contractions approach the perineum, the perineum is cut open. Then, when you have a strong contraction, you should try your best to use the force. The surgeon can open the hand and the baby's hips and lower limbs can be delivered smoothly. (3) Delivery of the shoulder: the surgeon wrapped the fetal buttocks with the treatment towel, put the thumb of both hands on the ankle, and the rest of the fingers hold the fetal hip, and gently pull and rotate with the contraction, so that the crotch is lowered and turned to positive In front, Eli's shoulders enter the pelvic entrance. At this point, the operator should pay attention to the hands and do not hold the fetal chest and abdomen, so as not to damage the internal organs. And when the umbilical part is delivered, gently pull the umbilical cord out a few centimeters to avoid excessive pulling when continuing to pull. While continuing to pull the fetal torso outwards and downwards, the back of the fetus is slowly turned back to the original lateral position, so that the double blind path is consistent with the anterior and posterior diameter of the pelvic outlet. When the armpit is visible under the pubic symphysis, the shoulder can be delivered in one of the following ways. 1 If you want to deliver the front shoulder, the surgeon will pull the fetal hip downwards, and the front shoulder and upper limbs can be naturally delivered. Then the carcass is up, and the back shoulder and upper limb can slide out of the vagina. You can also give the shoulder before delivery. The upper limb can not be delivered naturally, the surgeon can enter the birth canal with two fingers, press the elbow to bend it, and the baby hand can be naturally delivered. 2 Once the fetal crotch is seen, the outer edge of the fetal scapula is pushed toward the fetal spine, and the upper limb of the fetus can naturally slide out through the front chest of the fetus. 3 After one side of the shoulder and the upper limb are delivered according to any of the above methods, the carcass is rotated by 180°, and the other shoulder and the upper limb can be naturally delivered during the rotation. (4) Delivery of the fetal head: Turn the fetal back to the front, so that the sagittal suture of the fetal head is consistent with the anterior and posterior diameter of the pelvic outlet, and then the fetal head is delivered by one of the following two methods. 1 When the fetal head occipital bone reaches the pubic symphysis, the carcass is lifted in the direction of the mother's abdomen, so that it can be turned over to the pubic symphysis, and the fetal head can be delivered. 2mauriceau method: the carcass rides on the left forearm of the surgeon, while the left hand finger of the surgeon extends into the mouth of the fetus, and the top and upper jaws are attached, and the index finger and the ring finger are attached to the upper jaw bones; the right middle finger of the operator lowers the occipital portion of the fetal head. The flexion, the index finger and the ring finger are placed on both sides of the fetal neck, and then pulled down first, and the assistant applies appropriate pressure to the midline of the lower abdomen of the mother to keep the fetus bent. When the occipital part of the fetus is lower than the pubic bone, the carcass is gradually lifted up, and the occipital part is used as a fulcrum, so that the fetus's jaw, mouth, nose, eyes and forehead are successively delivered. 2. Supporting the law, that is, the bracht method: mainly used for the single hip first exposed, that is, the leg straight breech position. Because the lower extremities and torso of the fetus can better expand the cervix and vagina, and keep the two walls crossed in front of the chest to prevent lifting, so the single hip first exposed when there is no indication, do not interfere too early, try to make the hips Naturally delivered, when the umbilical part is delivered, the back of the fetus is up. The two thumbs of the surgeon are placed behind the thigh of the fetus. The other four fingers are placed on the ankle to hold the fetus, and the carcass is lifted and gently pulled until the feet are prolapsed. After the vagina, the rest of the fetus can be delivered by the method of blocking the buttocks. complication (1) maternal complications 1. The damage of the birth canal is related to the following factors: 1 The uterus is not open for vaginal midwifery, traction or posterior delivery. 2 The hip time is not enough or too long. 3 The operation is not standardized, and the technique is rude. After the delivery of the fetal placenta, routine examination of the cervix, suspected uterine rupture should be performed in the uterine cavity. If there is aura or complete rupture, the laparotomy should be performed immediately, and the surgical method should be determined according to the degree of rupture and the location. 2. Postpartum hemorrhage: It is related to the fact that the gluteal first dew can not evenly force the lower part of the uterus, but can not induce a good uterine contraction. In addition, there are many opportunities for surgical operation, and the chance of postpartum uterine contraction and impaired bleeding in the soft birth canal is also increased. Use the birth chart to guide the progress of labor, find and actively deal with difficult births in time, eliminate the delayed production, and effectively prevent postpartum hemorrhage. 3. Calving infection: Give antibiotics to prevent infection after childbirth. (two) fetal complications 1. Injury: The incidence rate is about 0.96% to 10%, which is related to the choice of delivery method and the experience of the delivery. (1) intracranial hemorrhage: mostly caused by mechanical damage and asphyxia. When the head is turned out, the fetal head cannot be deformed to adapt to the birth canal, and mechanical damage can occur when the fetal head is pulled. In particular, the head extension is more susceptible to injury. (2) Spinal injury: It is easy to occur when the hip is pulled. The damage often occurs between the seventh cervical vertebra and the second thoracic vertebra. If the spinal cord injury is accompanied, it can cause neonatal death, and the survivor will also leave permanent damage. (3) Hip plexus injury: The incidence rate is 17 times that of the head position, which is related to the excessive side traction when the fetal head is delivered. In severe cases, it can cause paralysis of the forearm. (4) radial nerve injury: related to excessive traction of the neck. It is characterized by difficulty in breathing. The levator muscle is elevated in the fluoroscopy, and the diaphragm is moving in the opposite direction with the inhalation. (5) Fracture: is the most common complication. The rise of the fetal arm is most likely to cause a fracture of the clavicle or tibia. Childbirth that violates the delivery mechanism can lead to fracture of the lower extremity. 2. Fetal and neonatal asphyxia: data reported significantly higher than the head position.

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