tailieunhanh - obstetrics_part9

phá hoại giao hàng 8. trong tử cung thủ tục Phá hoại hoạt động với mục đích là để giảm số lượng lớn của một thai nhi đã chết để tạo điều kiện thuận lợi cho sinh ngã âm đạo khi một vấn đề cơ khí ngăn chặn điều này xảy ra bình thường. | 8. Intrauterine procedures Destructive delivery Destructive operation whose aim is to reduce the bulk of a dead foetus in order to facilitate vaginal delivery when a mechanical problem prevents this from occurring normally. The goal is to avoid caesarean section and its attendant risks. Precautions All indications for destructive delivery are considered with respect to - the practitioner s experience and skill - the risk of trauma and infection associated with a difficult procedure on a fragile uterus and an infected cavity risk of uterine rupture damage to maternal soft tissue with subsequent fistulae - acceptance by both patient and staff of a procedure that might be psychologically traumatizing. Some practitioners prefer to perform a caesarean for a dead foetus rather than mutilate it. With caesarean section however there is a significant risk to the mother s life and function particularly when it is done in a remote rural setting. Foetal demise is not in itself justification for a caesarean. Caesarean section is only indicated for death in utero in exceptional circumstances when it is combined with a non-self-resolving mechanical obstacle for example transverse presentation with impacted shoulder and destructive delivery is impossible or the uterus has ruptured. Conditions - Make certain that the foetus is dead absence of heartbeat on foetal Doppler or ultrasound if available . - Establish that there is a mechanical obstacle to vaginal delivery due to size and or presentation. - Complete or nearly complete dilatation allowing sufficient access to the presenting part. - Inform the patient and possibly her family. - Perform the destructive delivery in the operating room under conditions of strict asepsis and under general anaesthesia. - Practitioner with obstetrical experience. - Urinary catheterization is mandatory. If urine is red suspect bladder injury and leave the catheter in place for 7 days. - After the extraction of the foetus always check the uterine .