hand-turned fetal head surgery

The manual ratification of the fetal head (manualratationoffelal) is to correct the fetal position by hand, in order to deal with the important operation of the head position dystocia, often combined with the forceps. Preoperative attention to monitor fetal heart rate, oxygen if necessary; disinfection of vulva, catheterization; vaginal examination, understanding of pelvic diameter, uterine sinus size, first exposed height and fetal position; check the integrity of the membrane, should be artificially ruptured Surgery; intravenous oxytocin, when the contraction is strong, should slow down the number of drops, so that the uterus relax, easy to rotate the fetal head; ready to rescue newborn suffocation drugs and supplies. Treatment of diseases: transverse dystocia persistent occipital transverse dystocia persistent persistent occipital dystocia Indication 1. Due to persistent occipital or posterior occipital position, the labor process is stagnant for more than 2 hours, the vaginal examination of the cervix is 6~9cm, or the second stage of labor is stagnant. 2. Need to produce forceps for midwifery or fetal head suction to shorten the second stage of labor, and the fetal position is the occipital or post-occipital position. Contraindications 1. The pelvic stenosis or the head basin is not called. 2. Placenta previa, placental abruption. 3. The uterus aura is ruptured. 4. Severe fetal distress. Preoperative preparation Pay attention to monitoring the fetal heart, oxygen if necessary; disinfect the vulva, catheterization; vaginal examination, understand the pelvic diameter, the size of the cervix, the height of the first exposed part and the position of the fetus; if the integrity of the membrane is checked, artificial rupture should be performed; It has been intravenously oxytocin, when the contraction is strong, the number of drops should be slowed down, the uterus should be relaxed, and the fetal head can be rotated; the newborn suffocation drugs and supplies should be prepared. Surgical procedure Take the left posterior position of the pillow as an example. The operator's right hand palm is facing up, the four fingers are placed on the back side of the fetal head, the thumb is placed on the front side of the fetal head, the fetal head is held, and the tire is gently pushed up to make the fetal head loose. Slowly rotate 180° counterclockwise, so that the forehead of the fetal head exceeds the maternal humerus, and the right front position of the pillow stops rotating, and the fetal head is gently held. When the contraction is completed, the fetal head is lowered, the basin is lowered, and then the tube is removed. Right hand, waiting for natural childbirth. If you need a forceps delivery child, rotate the fetal head to the anterior position of the pillow with a forceps fixed, and parallel forceps for childbirth. Medical teaching, breeding network|Collection and finishing, if the right rear position of the pillow, the right palm of the operator is facing down, the four fingers are placed on the front side of the fetal head, and the thumb is on the back side of the fetal head, and the fetal head is rotated clockwise 180 °, so that the fetal frontal bone exceeds the maternal humerus, which can be placed in the left front position. If it is a pillow horizontal position, you can rotate it by 135° according to the back position of the pillow. When the surgeon rotates the fetal head in the vagina, the other hand can be outside the abdominal wall and above the pubic symphysis to help the fetal head rotate. Or by the assistant on the side of the mother, hands on the abdominal wall of the mother to help the shoulder and the back of the tire rotate forward.