Fetal scalp blood sampling
Leroy C Edozien in The Labour Ward Handbook, 2010
If the CTG is suggestive of fetal distress then FBS from the scalp should always be undertaken before proceeding to CS, unless it is technically not possible to do so. Explain the procedure to the woman and obtain consent. The cervix must be at least 3 cm dilated and the presenting part should be no more than 2 cm above the plane of the ischial spines. The patient should be in the left lateral position or in the lithotomy position with a wedge. At least two samples should be taken on each occasion. After obtaining each sample, ensure haemostasis by applying pressure with a swab on the stab site. Inform the patient of the result and plan.
Internal Podalic Version and Breech Extraction
Malik Goonewardene in Obstetric Emergencies, 2021
Internal podalic version, which was apparently first described by Hippocrates, is a procedure where a series of manoeuvres are performed with one hand inside the uterus, with the aim of bringing one or both feet through a fully dilated cervix. Internal podalic version and breech extraction has also been described as an alternative to emergency caesarean delivery in a multigravid woman with a singleton fetus lying transversely, under exceptional circumstances such as profound bradycardia and there is delay in performing surgery or when the fetus is already dead. The woman should be placed in lithotomy position, cleaned and draped and her bladder should be emptied. Vaginal examination should be performed to be able to ensure full dilatation of cervix. Traction should be applied downwards and backwards in line with the longitudinal axis of the maternal pelvis in order to bring both feet or one foot into the vagina.
Normal Childbirth
Audrey Eccles in Obstetrics and Gynaecology in Tudor and Stuart England, 2018
It was generally assumed among people of the social classes who would call on professional attendants of repute, and who might be expected to know about and to demand the most modern and best treatment that childbirth was always painful and often dangerous. The obvious inference that patient expectation conditioned to a large extent the perception of childbirth as a painful, dramatic and dangerous process, or the reverse, was probably drawn first by Dr Grantley Dick-Read. On the psychological management of labour however, The birth of mankind gave good advice. By the end of the seventeenth century bed delivery was normal except among the poorest and most rural women, and the lithotomy position was the commonest. Obstetrics did of course change profoundly between the sixteenth and the eighteenth centuries, two of the most obvious changes being the invention of the obstetric forceps, and the irruption of men into midwifery practice.
Is bladder tumour fulguration under local anaesthesia more painful than cystoscopy only?
Published in Scandinavian Journal of Urology, 2020
Objectives: To prospectively register self-reported pain levels associated with office cystoscopy with or without bladder tumour biopsy and fulguration. Patients and methods: During a 15-month period, patients examined with cystoscopy under local anaesthesia graded their pain level using the Visual Analogue Scale (VAS). All patients were examined in the lithotomy position and lidocaine gel was used in all. A bladder instillation or a submucosal injection of lidocaine was given mainly in patients treated with extirpation of larger tumours. Results: The pain perception was graded by the patients as none (VAS = 0) or mild (VAS = 1–3) in 86% of the 1,314 cystoscopies. Fewer patients (65% out of 258) reported VAS 0–3 when cystoscopy with biopsy and fulguration of bladder tumour was performed. More than 97% of all patients stated that they would prefer treatment under local anaesthesia in the case of a future recurrence. Conclusion: The VAS-scores after diagnostic cystoscopy are in accordance with those previously reported, with the absolute majority reporting no or mild pain. Patients treated with extirpation of bladder tumours reported higher levels of pain but still within acceptable limits. This confirms the potential of treating most patients with small-sized bladder tumour recurrences under local anaesthesia.
Delivery of the deeply engaged head: a lacuna in training
Published in Journal of Obstetrics and Gynaecology, 2010
R. Sethuram, P. Jamjute, E. Kevelighan
The percentage of second stage caesarean sections is on the rise. The delivery of a deeply engaged head in the second stage by caesarean section is an experience feared by most junior registrars. Among the different delivery techniques described, the pull technique has been proven to have a lesser morbidity than the push technique. However, trainees do not receive any structured training in either of these methods. We undertook a survey among 150 UK trainees in SPROGS 2008 in order to understand their experience in dealing with a deeply engaged head in second stage by CS, to ascertain whether trainees feel that they need training to deal with the situation and to discover the means by which this training can be delivered. The questionnaire return rate was 94%. More than 80% agreed that they had faced difficulties in the past while trying to deliver a deeply engaged head. Only 20% used the recommended semi-lithotomy position during caesarean section for an impacted head. Among the trainees who had received only UK training, only 42% were confident of doing a pull method if the need arose. More than 80% of the trainees agreed that supervised sessions to teach alternative techniques for delivery, such as the reverse breech/pull method would be useful and that it would improve their confidence when doing a trial of vaginal delivery. The RCOG agreed that there is little formal training in delivery of a deeply engaged head and is considering recommending trainees complete 2 OSATS (Objective Structured Assessment Tools) in this area. It has also asked the authors to form a skills and drills protocol, which the authors have done and submitted to the RCOG.
Right radial nerve dysfunction following laparoscopic sigmoid colectomy
Published in Egyptian Journal of Anaesthesia, 2014
Yoshikazu Takinami, Daisuke Yagi, Masatoshi Morikawa, Masatsugu Yotsuya
Here, we report a case of right radial nerve dysfunction following laparoscopic sigmoid colectomy under general anesthesia. A 75-year-old man was intubated without excessive retroflexion, and his upper body was held in place by lateral body positioners with protective cushions over the chest and acromioclavicular joints. The patient’s head was maintained at the center and held on the operation table with a memory-foam pillow to prevent hyperextension of the neck. The arms, abducted 80° with the forearms supinated, were held in place on the armrests with protective cushions. The surgical position was a 20° head-down lithotomy position with the right side of the body lowered by 15°. Surgery was completed successfully with no complications, and anesthesia time was 7 h and 37 min. After surgery, however, the patient complained of numbness and hypoesthesia on the radial and ulnar side, respectively, of the right arm from the elbow to the fingertips, with the boundary running between fingers 3 and 4. Dysesthesia was observed in the right fingertips of fingers 1–3. After 3 months of silver spike point low-frequency electrotherapy, hypoesthesia improved, while dysesthesia partially improved, in the dorsal area between right fingers 1 and 2.