Tuesday, 19 March 2019

Shoulder Dystocia (arrest) -as in Risks associated with vaginal delivery of anencephalic foetus??


Anencephaly even at term pregnancy the small foetal head cones out through undilated say 5-7 cm dilation and then Cx refuses to dilate. In this case as because there is scar in uterus all doctors will be  worried about risks associated with   cleidotomy à Rupture uterus about of destructive operation Cleidotomyà division  of one  or both foetal clavicles, Dear members remember that bisacromial  diameter is  the largest diameter of foetus than brow. –This is applicable both for term as well as very preterm as is in this case... As such Mifegest followed by à Misoprostol / Foley induction os OK but to keep a vigil on rupture uterus out of in foetal manipulation which is a distinct possibility in this case. It is impossible that Cx will dilate by Misoprostol / Foley alone. By that I don’t mean that one should go for elective CS but I shall agree with the other members  of surgical induction but A) Counseling should be done about laparotomy B) Blood –PCV I unit  &  Anesthetist must be alerted whenever labour pains commences. C) Even if cleidotomy becomes unnecessary still she Badly warrant exploration of uterus is a must in this case. 

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