Indications

1. Prolonged 2nd stage of labor.

2. Shorten 2nd stage of labor for
maternal benefit.
3. Fetal Compromise.
4. Stabilize head during breech.

Kielland Forceps
Prerequisites
1. Fully dilated cervix, ruptured Simpson Forceps
membrane and engaged head into
pelvis.
2. No doubt regarding position of
fetal head.
3. Adequate anesthesia.
4. Empty bladder.

Two Extra for vacuum:

5. Pretem labor is contraindication.
6. Face or breech presentation is
contraindication.

Vacuum Extraction
Complications Forceps Complications Ventose
1. Traumatic vaginal and uterine injuries. 1. Cephalohematomas.
2. Trauma to maternal anal sphincter. 2. Subgaleal hematoma
3. Facial Palsy. 3. Scalp bruising and lacerations
4. Fetal Skull fracture 4. Maternal perineal lacerations
Symptoms
1. Lower abdominal pain
2. Amnenorrhea followed by
vaginal bleeding

Risk factors for ectopic pregnancy

1. History of STD or PID
2. Prior ectopic pregnancy
3. Previous Tubal Surgery
4. Endometriosis
5. IVF and ART
6. IUD

Surgical Rx
1. Exploratory laproscopy
2. Salpingostomy
3. Salpingectomy
4. Cornual Resection

Medical Rx
1. Methotrexate
Maternal Complications
1. Anemia
2. Hydramnois
3. Hypertension
4. PPH
5. Preecalmpsia
6. C/S

Fetal Complications
1. Malpresentation
2. Placenta previa
3. PROM
4. IUGR
5. Prematurity.
6. Umbilical cord prolapse
7. Increase perinatal M&M
Indications
1. Contraception.
2. Dysmenorrhia.
3. Menorrhagia.

Contraindications
1. Active cervical infection.
2. Cervical cancer
3. Distortion of uterine cavity
4. Uterine cavity that is not correct size.

Complications
1. Unscheduled bleeding
2. Spotting in early months
3. Expulsion
4. Uterine perforation during insertion.
5. Ectopic pregnancy
 Indications
1. Uterine Prolapse
2. Vaginal Prolapse
3. Stress urinary incontinence

Risk factors of prolapse

1. Postmenopausal (2nd to decrease
estrogen).
2. Multiparity and traumatic delivery.
3. Caucasian (ethnicity) Hodge (Ring) Pessary
4. Hysterectomy and pelvic surgery
5. Connective tissue defect

Symptoms
1. Low back pain
2. Urinary urge incontinence
3. Sensation of bulging
4. Constipation
Diagnosis
Single-blade speculum examination
asking the patient to strain down.

Staging
Hymen plane is defined as zero
0 No prolapse (-3 cm)
1 Above hymen (-1)
2 Level of hymen (-1 to +1)
3 Beyond hymen (> +1)
4 Complete eversion

Complete Procidentia
 Uterine prolapse through vaginal hymen represents failure of all
the vaginal supports.
 Complications: excessive purulent discharge, decubitus ulcers,
bleeding, and rarely carcinoma of the cervix.

Managements
1) Nonsurgical: Kegel excersise and pessaries (unfit or refusing
surgery, during pregnancy, post-partum)
2) Surgical: Anterior and posterior colporrhaphy (cystocele &
enterocele), colpopexy (apical prolapse)
 Elective C/S
1. Previous classical C/S
2. Placenta previa.
3. Active herpes.
4. HIV
5. Breech .
6. Twins not in cephalic-
cephalic or more than three
fetuses

Emergency C/S
1. Dystocia
2. Fetal distress
3. Cord prolapse
4. Uterine rupture

Complication C/S
1. Hemorrhage
2. Fetal injury
3. Injury to surrounding organs
4. Blood clots.
5. Increase risk during future pregnancies.
Uses
1. Monitor fetal heart rate.
2. Repetitive decels.
3. Difficult external trace (obesity)
4. Twins
Contraindications
1. Hepatitis or HIV
2. Fetal thrombocytopenia

Indication for AROM Fetal scalp electrode (FSE)

1. PET, DM, Heart disease.
2. Prolonged pregnancy
3. IUGR
4. Chorioamnionities

Complication of Oxytocin for Ind. & Aug.

1. Hyperstimulation (excessive infusion) possible rupture of uterus
and fetal distress.
2. Severe water intoxication with convulsions (antidiuretic effect). Amnihook
3. Post-delivery uterine atony.
Uses
Gyn:
1. Pap smear
2. Endometrial biopsy
3. Prolapse

Obstetrics:
4. D&C
5. Abortion
Devilbiss Speculum Cusco Speculum
6. Hystrectomy

Complications
1. Vaginal laceration
2. Urethral damage
3. Patient discomfort

Graves Speculum Sims Speculum

Curette
Doytens Retractor
Hegar’s Cervical Dilators

Tenacullum
Cervical Spatula and Cytobrush