GTG Perineal tears-
1. Overall incidence- 2.9% (0-8%)::::6.1% in primi, 1.7% in multi
2. Rectal buttonhole tear- tear involving rectal mucosa with intact anal sphincter complex; if not repaired—->rectovag fistula
3. Mediolateral episiotomy preferred —>angle 60 degrees away from midline (post delivery angle of 45degrees )
4. For IAS and partial thickness EAS—->end to end technique
For full thickness EAS tear—->overlap or end to end technique
5. Anorectal mucosa——> 3-0 polyglactin
EAS/IAS muscle——> monofilament 3-0 PDS or modern braided (2-0 polyglactin)
Severe maternal morbidity rate-6/1000
Maternal mortality rate-14/100000 births
Rate of maternal collapse=0.14-6/1000 births
MCC of maternal collapse-haemorrhage
MCC of direct maternal death-vte
MCC overall cause of maternal death- cardiac
Major hge incidence-3.7/1000 maternities
incidence of AFE-2/100000 maternities
Perinatal mortality with AFE-135/1000 total births
Incidence of anaphylaxis-3-10/1000
Mortality-1%
Uterine blood flow 10%of total circulation at term
Plasma volume increases by 50%
Heart rate increases by 15-20bpm
Cardiac output increases by 40% and is decreased by 30-40% by the gravid uterus
Arterial bp decreases by 10-15mmHg
O2 consumption increases by 20%
Residual capacity decreases by 25%
15° lateral tilt to the left
Chest compression to ventilation ratio 30:2 (intubated- desynchronised with compression-100/min n ventilation 10/min)
Perimortem cs to be done if no response to correct CPR in 4min and to be done within 5 min of collapse
Irreversible brain damage in 4-6min
Sepsis care bundle read plz
Intralipid 20% rescue dose read plz
Anaphylaxis- 500microgm (0.5ml 1:1000 im adrenaline)
50microgm (0.5ml 1:10000 adrenaline slow iv in experienced hands)
Adjuvants- chlorpheniramine 10mg and hydrocortisone 200mg Im or slow iv
Submitted by – Shirisha
#Shoulder dystocia-
Incidence-0.6-0.7%
Incidence of pph-11%
3/4 degree perineal tear-3.8%
BPI-2.3-16%
Less than 10%BPI results in permanent dysfunction
46% injuries are d/t substandard care
Risk assessment is predictive in 16% cases
48% of SD occurs in infants with BW<4kg
Infants of mothers with GDM -2-4FOLD rise
Recurrence rates for SD-1-25%
humerus# after delivery of posterior arm=2-12%
Success rates of all fours-83%