2007 AKCOG 2012

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An innovative method of baby delivery at Caesarean section: 

An innovative method of baby delivery at Caesarean section Dr. Shyjus.P Asst. Professor MES Medical college Perinthalmanna

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Millions of caesareans are being done every year around the world. The Big question! Have we really mastered this surgery?

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Caesarean section, a risk factor for atonicity ! Commonly attributed to the absence of uterine activity and rapid evacuation of intrauterine contents Can we simulate the principles of normal delivery at a CS?

Why an improvisation is required?: 

Why an improvisation is required? Difficulties during a caesarean is still a common problem! difficulty in entering the abdomen difficulty in approaching the LUS difficulty in baby delivery difficulty with placental delivery difficulty with an atonic uterus

Steps : 

Steps Pre-incision oxytocin infusion Ensure presence of uterine contractions Adequate uterine incision Slide maneauveur to deliver the fetal head Initial neonatal resuscitation on table Support the fetal head and shoulders Allow a ‘near total’ spontaneous delivery of the baby Cord clamping Removal of an already seperated placenta presenting at the uterine incision Uterine closure

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Benefits of this technique: 

Benefits of this technique Effortless and ‘near total’ spontaneous baby delivery at CS Avoidance of fundal pressure Ensures an easy and complete removal of placenta Reduces the blood loss at a CS Avoids genital tract trauma at a CS Avoids post-partum uterine atonicity Reduces the post-operative pelvic and abdominal discomfort for the mother Hence reduces post-operative analgesic requirements

Challenges faced!: 

Challenges faced! General disposition among anesthetists against pre-incision oxytocin usage The worry about post-spinal hypotension!

Overcoming challenges: 

Overcoming challenges The beauty of a normal delivery lies in the concept of living ligature ….. Hence a physiologically acceptable technique Minimum 2 minutes available to deliver the baby from the time of uterine incision, to prevent hypoxia and low APGARS in neonates…. this delivery technique just takes 45-60 seconds

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“ To be inactive at required times, is a masterly act! ”

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Try out this ‘near total’ spontaneous delivery at CS and feel the difference! @ shyjusnair7479@gmail.com

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Thank You