*CHAPTER NO 12
OBSTETRIC
OPERATIONS
AMINA GUL
RN,RM,POSTRN
*Definition:
*A surgical procedure in which the cervix is
dilated and the contents of the uterus
are evacuated using suction and/or
instruments.
*DILATION AND
EVACUATION
PREPARED BY AMINA GUL 2
*Indications:
*Second-trimester abortion (usually 13–
24 weeks).
*Incomplete abortion or missed abortion.
*Molar pregnancy evacuation.
*Retained products of conception.
*INDICATIONS
PREPARED BY AMINA GUL 3
*Cervical dilation (mechanical dilators or
prostaglandins like misoprostol).
*Evacuation of uterine contents using
suction cannula, forceps, or curette.
*Uterotonic drugs (oxytocin/ergometrine)
given to contract uterus.
*Check uterus for completeness.
*Procedure
(General Steps):
PREPARED BY AMINA GUL 4
* Advantages:
* Effective and safe method of second-trimester abortion.
* Quicker than medical induction.
* Complications:
* Hemorrhage
* Uterine perforation
* Infection
* Cervical injury
* Intrauterine adhesions (Asherman’s syndrome, rare)
PREPARED BY AMINA GUL 5
* 🔹 Definition:
It is a surgical method in which the uterus is emptied
using a suction device (vacuum) and sometimes
curettage (gentle scraping).
* 🔹 Indications (when it is done):
* Incomplete abortion (some pregnancy tissue left inside)
* Missed abortion (pregnancy stopped but not expelled
naturally)
* Molar pregnancy (abnormal growth instead of normal
pregnancy)
* To terminate pregnancy (in early weeks)
* Heavy bleeding due to retained products after delivery
*SUCTION
EVACUATION
PREPARED BY AMINA GUL 6
* 🔹 Procedure (basic idea):
* Patient is given anesthesia (local or general).
* Cervix is dilated (opened).
* A suction tube (cannula) is inserted into the uterus.
* Contents are removed by suction, sometimes
followed by gentle curettage.
* 🔹 Benefits:
* Quick procedure
* Usually safe if done by trained doctor
* Controls bleeding and prevents infection
* 🔹 Risks/Complications (rare):
* Uterine perforation
* Infection
* Excessive bleeding
* Asherman’s syndrome (scar formation in uterus,
rare)
PREPARED BY AMINA GUL 7
* Definition: Use of a metal instrument
(forceps shaped like large spoons) to gently
pull the baby out during vaginal delivery.
* When used:
* Baby’s head is low in birth canal but mother
cannot push effectively
* Prolonged labor
* Fetal distress (baby’s heartbeat dropping)
* Risk: May cause bruising to baby’s head or
injury to mother’s birth canal.
*FORCEP
DELIVERY
PREPARED BY AMINA GUL 8
* Ventouse (Vacuum Extraction)
* Definition: A suction cup (ventouse) is
applied to the baby’s head and with gentle
suction + pulling, baby is delivered.
* When used:
* Similar reasons as forceps (prolonged labor,
fetal distress)
* Preferred over forceps if less trauma is needed
* Risk: Baby may get scalp swelling (caput) or
small bleeding under scalp, but usually heals.
PREPARED BY AMINA GUL 9
* Version
* Definition: A maneuver done by the doctor to turn the
baby into a correct position before or during delivery.
* Types:
* External Cephalic Version (ECV): Doctor applies
pressure on mother’s abdomen to turn breech baby (legs
first) into head-first position.
* Internal Podalic Version: Doctor puts hand inside uterus
(rarely used, usually for second twin) to turn baby for
delivery.
* Purpose: To help baby come in normal head-first
position.
PREPARED BY AMINA GUL 10
* Cesarean Section (C-Section)
* Definition: A surgical operation where the baby is
delivered through cuts made in mother’s abdomen and
uterus.
* When used:
* Baby in distress
* Breech or abnormal position
* Placenta previa (placenta blocking birth canal)
* Previous C-section or uterine surgery
* Obstructed labor (baby too big / pelvis too small)
* Risk: Major surgery → infection, bleeding, longer
recovery time
PREPARED BY AMINA GUL 11
*Symphysiotomy
*Definition: A surgical procedure in which
the pubic symphysis (joint in front of
pelvis) is cut to widen the pelvis.
*Use: Rare now, used only in obstructed
labor when C-section is not available.
*Risk: Pain, difficulty walking, injury to
bladder/urethra.
PREPARED BY AMINA GUL 12
* Hysterectomy
* Definition: Surgical removal of the uterus
(womb).
* Types:
* Total hysterectomy → uterus + cervix removed
* Subtotal hysterectomy → only uterus body
removed, cervix left
* With oophorectomy → uterus + ovaries removed
* Indications: Uterine fibroids, cancer, severe
bleeding, prolapse.
PREPARED BY AMINA GUL 13
*Episiotomy
*Definition: A small surgical cut made
in the perineum (area between vagina and
anus) during delivery.
*Purpose: To enlarge vaginal opening and
prevent uncontrolled tearing.
*When done: Prolonged labor, big baby,
instrumental delivery (forceps/ventouse).
PREPARED BY AMINA GUL 14
* Amnioinfusion
* Definition: Infusion of warm sterile fluid into
the amniotic sac through a catheter in the uterus
during labor.
* Purpose:
* To dilute thick meconium in amniotic fluid (reduce risk
of aspiration)
* To relieve umbilical cord compression (improves
oxygen supply to baby).
* 5. Sterilization
* Definition: A permanent method of
contraception.
* In females: Tubal ligation (fallopian tubes cut or
tied).
* In males: Vasectomy (vas deferens cut/blocked).
* Purpose: Permanent prevention of pregnancy.
PREPARED BY AMINA GUL 15