Medically assisted normal delivery

Medically assisted normal delivery, also known as assisted vaginal delivery, refers to the use of medical interventions to help a woman give birth vaginally. This is usually done when the baby is having difficulty descending through the birth canal or when the mother is unable to push effectively.
There are several types of medical interventions that can be used during a medically assisted normal delivery. These include:
- Forceps : A tool that looks like a large pair of tongs and is used to guide the baby’s head with gentle care through the birth canal.
- Vacuum extraction : A soft cup is placed on the baby’s head, and a vacuum is used to help guide the baby through the birth canal.
- Episiotomy : A small incision is made in the tissue between the vagina and anus to widen the birth canal and make it easier for the baby to pass through.
- Induction : Medications are used to stimulate contractions and help the cervix dilate.
- Augmentation : Medications are used to strengthen contractions that have slowed down or stopped.
- Right fetal size and position.
- Suitable maternal health.
- The smooth progress of labour.
- Normal dilation of the cervix.


Caesarean section

During a C-section, the mother is given anaesthesia but left awake during the procedure. The surgeon makes a horizontal or vertical incision in the lower abdomen and uterus and delivers the baby. The incision is then closed with stitches or staples.
C-sections can be planned in advance, called an elective C-section, or done as an emergency if complications arise during labour. Some of the reasons for a planned or emergency C-section may include the following:
- The baby is in a breech position, meaning that the baby’s feet or buttocks are facing downwards instead of its head.
- The baby is too large to smoothly pass through the birth canal.
- The mother has a medical condition that makes vaginal delivery unsafe, such as placenta previa, where the placenta covers the cervix.
- The mother has had a previous C-section.
1. Foetal distress
2. Deep transverse arrest
3. Obstructed labour
4. Scar Dehiscence
5. Hand prolapse
6. Umbilical cord prolapse
7. Placenta Praevia with heavy bleeding.
8. Abruptio placentae
b) Elective C-section
1. Big baby with CPD
2. Central Placenta Praevia
3. Transverse Lie
4. Contracted pelvis
5. Less foetal movements
Caesarean section

During a C-section, the mother is given anaesthesia but left awake during the procedure. The surgeon makes a horizontal or vertical incision in the lower abdomen and uterus and delivers the baby. The incision is then closed with stitches or staples.
C-sections can be planned in advance, called an elective C-section, or done as an emergency if complications arise during labour. Some of the reasons for a planned or emergency C-section may include the following:
- The baby is in a breech position, meaning that the baby’s feet or buttocks are facing downwards instead of its head.
- The baby is too large to smoothly pass through the birth canal.
- The mother has a medical condition that makes vaginal delivery unsafe, such as placenta previa, where the placenta covers the cervix.
- The mother has had a previous C-section.
1. Foetal distress
2. Deep transverse arrest
3. Obstructed labour
4. Scar Dehiscence
5. Hand prolapse
6. Umbilical cord prolapse
7. Placenta Praevia with heavy bleeding.
8. Abruptio placentae
b) Elective C-section
1. Big baby with CPD
2. Central Placenta Praevia
3. Transverse Lie
4. Contracted pelvis
5. Less foetal movements

Internal iliac artery ligation

The internal iliac artery supplies blood to the pelvic organs, including the bladder, rectum, and reproductive organs. By ligating this artery, blood flow to these organs is temporarily stopped, which can help to control bleeding.
Internal iliac artery ligation is usually done as a last resort when other methods of controlling bleeding have failed. The procedure is typically done under general anaesthesia and involves making an incision in the abdomen or pelvic area to access the internal iliac artery. The typical indications of the surgery include:
- Severe postpartum haemorrhage
- Pelvic malignancy
- Pelvic trauma
- Pelvic infections
- Uterine fibroids


Fertility-promoting surgical procedures

Fertility-promoting surgical procedures are surgical techniques that aim to increase a woman’s chances of becoming pregnant. These procedures may be recommended for women who have difficulty conceiving due to structural abnormalities or blockages in the reproductive system.
Some examples of fertility-promoting surgical procedures include:
2. Hysteroscopy: A minimally invasive surgical procedure that uses a small camera inserted through the vagina to examine the uterus and remove uterine polyps, fibroids, or adhesions that may be interfering with implantation.
3. Tubal surgery: A surgical procedure that involves repairing or reconstructing the fallopian tubes, which can suffer blockage due to infection, scar tissue, or other conditions.
4. Ovarian drilling: A surgical procedure that uses heat or laser to make small holes in the ovaries, which can stimulate ovulation and increase the chances of conception.
Fertility-promoting surgical procedures can be effective in improving a woman’s chances of becoming pregnant, but they may not be suitable for everyone.
Fertility-promoting surgical procedures

Fertility-promoting surgical procedures are surgical techniques that aim to increase a woman’s chances of becoming pregnant. These procedures may be recommended for women who have difficulty conceiving due to structural abnormalities or blockages in the reproductive system.
Some examples of fertility-promoting surgical procedures include:
2. Hysteroscopy: A minimally invasive surgical procedure that uses a small camera inserted through the vagina to examine the uterus and remove uterine polyps, fibroids, or adhesions that may be interfering with implantation.
3. Tubal surgery: A surgical procedure that involves repairing or reconstructing the fallopian tubes, which can suffer blockage due to infection, scar tissue, or other conditions.
4. Ovarian drilling: A surgical procedure that uses heat or laser to make small holes in the ovaries, which can stimulate ovulation and increase the chances of conception.
Fertility-promoting surgical procedures can be effective in improving a woman’s chances of becoming pregnant, but they may not be suitable for everyone.

Management of PPH

The management of PPH may involve the following steps:
2. Uterine massage and medication : The healthcare provider may massage the uterus to induce it to contract and stop bleeding. Medications such as oxytocin, misoprostol, or carboprost may also be given to help the uterus contract.
3. Surgical intervention : If the bleeding does not stop with uterine massage and medication, surgical intervention may be necessary. This can include uterine artery ligation, embolization, or hysterectomy.
4. Blood products : In severe cases of PPH, blood transfusions may be necessary to replace the lost blood volume.
5. Monitoring and follow-up : The mother’s condition should be closely monitored, and she should receive follow-up care to ensure that she has fully recovered.
Preventative measures, such as early identification of high-risk women, active management of the third stage of labour, and skilled birth attendants, can also help to reduce the incidence of PPH.


Macdonald stitch for cervical incompetence

The Macdonald stitch involves placing a suture around the cervix to keep it closed and prevent premature labour. The procedure is typically performed around the 12th-14th week of pregnancy or earlier in cases where there is a history of cervical incompetence or premature delivery.
During the procedure, the patient is typically given anaesthesia, and the surgeon uses specialized instruments to place the suture around the cervix. The suture is then tied in a knot to hold the cervix closed.
After the procedure, the patient may be required to rest in the hospital for a short period of time for observation. They may also be recommended complete bed rest or other precautions to reduce the risk of complications.
The Macdonald stitch has been shown to be an effective treatment for cervical incompetence and can help prevent premature delivery and other complications. The need for this surgery may stem from the followings:
- History of preterm birth
- Cervical incompetence
- Short cervix
- Multiple gestations
Macdonald stitch for cervical incompetence

The Macdonald stitch involves placing a suture around the cervix to keep it closed and prevent premature labour. The procedure is typically performed around the 12th-14th week of pregnancy or earlier in cases where there is a history of cervical incompetence or premature delivery.
During the procedure, the patient is typically given anaesthesia, and the surgeon uses specialized instruments to place the suture around the cervix. The suture is then tied in a knot to hold the cervix closed.
After the procedure, the patient may be required to rest in the hospital for a short period of time for observation. They may also be recommended complete bed rest or other precautions to reduce the risk of complications.
The Macdonald stitch has been shown to be an effective treatment for cervical incompetence and can help prevent premature delivery and other complications. The need for this surgery may stem from the followings:
- History of preterm birth
- Cervical incompetence
- Short cervix
- Multiple gestations

Salpingo-oophorectomy

- ovarian or fallopian tube cancer
- endometriosis
- ovarian cysts.
- Pelvic inflammatory diseases
- Benign ovarian or fallopian tube cancer
During the procedure, the surgeon carefully removes one or both ovaries and fallopian tubes. In some cases, the uterus may also be removed (hysterectomy), particularly in cases where cancer is present.
After the procedure, the patient may need to bide their time in the hospital for a short period of time for further observation. Recovery time is relative to the specifics of the procedure, but most women can return to normal activities within a few weeks.
Salpingoophorectomy is generally considered a safe procedure, but it may be associated with some risks, such as bleeding, infection, or damage to surrounding organs. Removal of the ovaries can also cause menopause, and hormone replacement therapy may be recommended to manage symptoms.
Salpingoophorectomy can be an effective treatment for certain medical conditions and can help prevent the development of ovarian or fallopian tube cancer.


Ovariotomy

- ovarian cancer
- ovarian cysts
- endometriosis
- to prevent the growth of ovarian tumours
During the procedure, the surgeon carefully removes one or both ovaries and, in some cases, may also remove the fallopian tubes and/or uterus. It could be an extremely effective treatment to proactively prevent the onslaught of ovarian cancer.
Ovariotomy

- ovarian cancer
- ovarian cysts
- endometriosis
- to prevent the growth of ovarian tumours
During the procedure, the surgeon carefully removes one or both ovaries and, in some cases, may also remove the fallopian tubes and/or uterus. It could be an extremely effective treatment to proactively prevent the onslaught of ovarian cancer.

Removal of ectopic pregnancy

Removal of an ectopic pregnancy might be conducted through laparoscopic surgery or laparotomy, depending on the size and location of the pregnancy. During the procedure, the surgeon drills a small incision in the abdomen and carefully removes the ectopic pregnancy, which may as well involve removing a portion of the fallopian tube. The possible indications for the surgery are:
- Risks of fallopian tube rupture
- High-risk location of the pregnancy
