Obstetrics and Gynecology: Examination Essentials

Posted on Mar 17, 2025 in Social Anthropology

EXAMINATION TICKET – 1

1. Thrombohemorrhagic Syndrome in Obstetrics: Emergency Care

Answer: Thrombohemorrhagic syndrome, also known as disseminated intravascular coagulation (DIC), is a severe and life-threatening condition that can occur in obstetrics. It involves widespread activation of the coagulation cascade, leading to the formation of blood clots throughout the body’s small blood vessels. This can result in organ damage due to restricted blood flow and simultaneous severe bleeding due to the consumption of platelets and coagulation factors.

Emergency Care for Thrombohemorrhagic Syndrome in Obstetrics

1. Immediate Assessment and Diagnosis:
   • Clinical Signs: Look for signs of bleeding (such as vaginal bleeding, petechiae, or bleeding from IV sites) and signs of organ dysfunction (such as altered mental status or oliguria).
   • Laboratory Tests: Key tests include complete blood count (CBC), coagulation profile (PT, aPTT), fibrinogen levels, D-dimer, and liver and renal function tests.
2. Stabilization and Supportive Care:
   • Hemodynamic Support: Ensure adequate IV access, monitor vital signs, and administer fluids to maintain blood pressure and perfusion.
   • Oxygenation: Provide supplemental oxygen to ensure adequate tissue oxygenation.
   • Blood Product Transfusion: Administer blood products as needed, including packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate to manage bleeding and replenish consumed coagulation factors.
3. Treat Underlying Cause:
   • Manage Obstetric Complications: Conditions such as placental abruption, amniotic fluid embolism, severe preeclampsia, or sepsis must be promptly treated.
   • Delivery: In cases of severe preeclampsia or other life-threatening obstetric conditions, expediting delivery may be necessary.
4. Pharmacologic Interventions:
   • Anticoagulants: In certain situations, low-dose heparin may be considered to inhibit further thrombin generation, but this is usually reserved for specific cases under careful monitoring.
   • Medications for Blood Pressure: If the patient is hypertensive, antihypertensive medications may be necessary.
5. Monitoring and Follow-Up:
   • Continuous monitoring of vital signs, urine output, and repeated laboratory tests to assess the effectiveness of the interventions and the progression of the condition.
   • Multidisciplinary care involving obstetricians, hematologists, intensivists, and neonatologists if the fetus is at a viable gestational age.

2. Uterine Fibroids: Treatment Methods and Operative Indications

Answer:

Treatment Methods for Uterine Fibroids

Uterine fibroids, also known as leiomyomas or myomas, are benign tumors of the uterus. Treatment options vary based on symptoms, size, location, patient age, and desire for future fertility.

1. Medical Management

• Hormonal Therapies:
  • Gonadotropin-Releasing Hormone (GnRH) Agonists: Reduce fibroid size and bleeding by inducing a hypoestrogenic state.
  • Oral Contraceptives: Control menstrual bleeding but have limited effects on fibroid size.
  • Progestins and Levonorgestrel-Releasing Intrauterine Devices (IUDs): Reduce menstrual bleeding.
• Non-Hormonal Therapies:
  • Tranexamic Acid: Reduces menstrual bleeding.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Alleviate pain and reduce bleeding.

2. Minimally Invasive Procedures

• Uterine Artery Embolization (UAE): Cuts off blood supply to fibroids, causing them to shrink. Suitable for women who do not wish to preserve fertility.
• Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS): Uses high-intensity ultrasound waves to destroy fibroid tissue.

3. Surgical Treatments

• Myomectomy: Surgical removal of fibroids while preserving the uterus. Indicated for women who wish to retain fertility.
  • Hysteroscopic Myomectomy: For submucosal fibroids.
  • Laparoscopic Myomectomy: For intramural or subserosal fibroids.
  • Open Myomectomy: For large or multiple fibroids.
• Hysterectomy: Complete removal of the uterus. Definitive treatment for women who do not desire future fertility.
  • Subtotal (Supracervical) Hysterectomy: Removal of the uterine body while leaving the cervix.
  • Total Hysterectomy: Removal of both the uterus and cervix.
  • Radical Hysterectomy: Removal of the uterus, cervix, part of the vagina, and surrounding tissues, usually for suspected or confirmed malignancy.

Indications for Operative Treatment

Surgical intervention is considered based on several factors, including the severity of symptoms, size and location of fibroids, and patient’s reproductive goals. Indications include:

1. Severe Symptoms:
   • Persistent heavy menstrual bleeding leading to anemia.
   • Significant pelvic pain or pressure affecting quality of life.
   • Bladder or bowel dysfunction due to fibroid pressure.
2. Fibroid Characteristics:
   • Rapid growth or large size causing significant symptoms.
   • Submucosal fibroids causing heavy bleeding or infertility.
3. Reproductive Goals:
   • Infertility or recurrent pregnancy loss attributed to fibroids.
   • Desire for future fertility with symptomatic fibroids unresponsive to medical therapy.
4. Failure of Medical Management:
   • Ineffective symptom relief with medical therapy.
   • Side effects or contraindications to medical treatments.
5. Suspicion of Malignancy:
   • Uncertain diagnosis where malignancy (e.g., leiomyosarcoma) cannot be ruled out.

3. Ascending Gonorrhea: Clinical Presentation and Treatment

Answer:

Clinical Presentation

Ascending gonorrhea refers to the spread of the Neisseria gonorrhoeae infection from the lower genital tract to the upper genital tract, which can lead to more severe complications. This can manifest as:

1. Pelvic Inflammatory Disease (PID):
   • Symptoms: Lower abdominal pain, fever, abnormal vaginal discharge, painful intercourse (dyspareunia), irregular menstrual bleeding, and pain during urination (dysuria).
   • Signs: Cervical motion tenderness, uterine tenderness, adnexal tenderness, and fever.
2. Endometritis:
   • Inflammation of the uterine lining causing abdominal pain, fever, and abnormal bleeding.
3. Salpingitis:
   • Inflammation of the fallopian tubes presenting with severe abdominal pain, fever, and possible abscess formation.
4. Peritonitis:
   • Inflammation of the peritoneum causing severe abdominal pain, distension, and systemic signs of infection.
5. Fitz-Hugh-Curtis Syndrome:
   • Perihepatitis causing right upper quadrant pain, which can be mistaken for gallbladder or liver disease.

Treatment

The treatment of ascending gonorrhea involves antibiotics, typically a combination to cover potential co-infection with Chlamydia trachomatis, which commonly coexists with gonorrhea.

1. Recommended Regimen:
   • Ceftriaxone 500 mg IM (intramuscularly) in a single dose (1 gram if the patient weighs ≥150 kg).
   • Doxycycline 100 mg orally twice daily for 7 days, to cover possible chlamydial co-infection. (Note: If the patient is pregnant, azithromycin 1 g orally in a single dose is preferred instead of doxycycline).
2. Alternative Regimens:
   • If ceftriaxone is unavailable: Cefixime 800 mg orally in a single dose plus doxycycline as above.
   • For patients with severe cephalosporin allergy: Gentamicin 240 mg IM plus azithromycin 2 g orally in a single dose.
3. Hospitalization Criteria:
   • Severe clinical illness (e.g., high fever, nausea, vomiting).
   • Presence of a tubo-ovarian abscess.
   • Inability to follow or tolerate an outpatient oral regimen.
   • Pregnancy.

Criteria for Cure

The cure for gonorrhea is confirmed through a combination of clinical resolution of symptoms and follow-up testing:

1. Clinical Criteria:
   • Resolution of symptoms such as abdominal pain, fever, and abnormal discharge.
   • No new symptoms suggestive of ongoing infection.
2. Laboratory Criteria:
   • Test of Cure (TOC): While not routinely recommended for all cases, a TOC is advised in cases of persistent symptoms, treatment failure, or if non-standard treatment regimens were used. This typically involves a nucleic acid amplification test (NAAT) conducted 7-14 days after completing treatment.
3. Follow-Up:
   • Patients should be re-evaluated within 3 months of treatment, even if asymptomatic, to ensure there is no reinfection, as reinfection rates are high.
4. Partner Notification and Treatment:
   • Sexual partners should be notified, tested, and treated to prevent reinfection and further spread of the disease.

EXAMINATION TICKET – 2

1. Anatomically Narrow Pelvis: Forms, Degrees, Management

Answer: Anatomically narrow pelvis refers to a pelvis that is smaller than average, which can cause difficulties during childbirth.

Forms of Anatomically Narrow Pelvis

• Contracted Pelvis: True (Obstetric) Conjugate: Less than 11 cm.
• Diagonal Conjugate: Less than 12.5 cm.

Forms of Narrowing:

• General Contraction: All dimensions of the pelvis are reduced.
• Flat Pelvis: Reduced anteroposterior diameter.
• Android Pelvis: Heart-shaped brim, with a narrow anterior segment.
• Anthropoid Pelvis: Oval brim, with a longer anteroposterior diameter.
• Platypelloid Pelvis: Flat, wide pelvis with a short anteroposterior diameter.

Degrees of Narrowing

The degrees of pelvic narrowing are typically classified based on the amount of reduction in pelvic dimensions:

• Mild (First Degree): True Conjugate: 10-11 cm. Bispinous Diameter: Reduced by 1-1.5 cm.
• Moderate (Second Degree): True Conjugate: 8.5-10 cm. Bispinous Diameter: Reduced by 1.5-2 cm.
• Severe (Third Degree): True Conjugate: 7-8.5 cm. Bispinous Diameter: Reduced by 2-2.5 cm.
• Very Severe (Fourth Degree): True Conjugate: Less than 7 cm. Bispinous Diameter: Reduced by more than 2.5 cm.

Management in Women’s Ambulatory Consultations

1. Assessment:
   • Pelvimetry: Clinical pelvimetry involves manual examination to estimate pelvic dimensions. Radiologic pelvimetry, using X-rays, CT, or MRI, provides more precise measurements.
   • Obstetric History: Previous delivery outcomes can provide insights into potential complications.
   • Ultrasound: Assess fetal size, position, and development to plan the mode of delivery.
2. Prenatal Counseling and Planning:
   • Risk Discussion: Inform the patient about potential complications associated with a narrow pelvis, such as prolonged labor, obstructed labor, and the increased likelihood of cesarean delivery.
   • Birth Plan: Develop a birth plan that includes potential scenarios, such as trial of labor versus planned cesarean section.
3. Monitoring and Follow-Up:
   • Frequent Visits: Regular monitoring of fetal growth and maternal health.
   • Non-Stress Tests (NST) and Biophysical Profile (BPP): Assess fetal well-being, especially as the due date approaches.
   • Discussion of Signs of Labor: Educate the patient on when to seek immediate medical attention
4. Labor and Delivery Management:
   • Trial of Labor: For women with mild to moderate pelvic narrowing, a trial of labor may be considered, with careful monitoring for any signs of obstructed labor.
   • Cesarean Delivery: Indicated in cases of severe pelvic narrowing, abnormal fetal positions, or if complications arise during a trial of labor.

2. Precancer of the Cervix and Cancer Prevention

Answer: Precancerous conditions of the cervix, also known as cervical dysplasia or cervical intraepithelial neoplasia (CIN), are changes in the cells on the surface of the cervix that have the potential to develop into cervical cancer. These changes are classified based on their severity:

1. Cervical Intraepithelial Neoplasia (CIN):
   • CIN 1 (Mild Dysplasia): Abnormal changes in the lower third of the cervical epithelium.
   • CIN 2 (Moderate Dysplasia): Abnormal changes in the lower two-thirds of the cervical epithelium.
   • CIN 3 (Severe Dysplasia/CIS – Carcinoma In Situ): Abnormal changes extending through more than two-thirds of the cervical epithelium, potentially involving the full thickness.
2. Atypical Squamous Cells (ASC):
   • ASC-US (Atypical Squamous Cells of Undetermined Significance): Unclear if changes are benign or precancerous.
   • ASC-H (Atypical Squamous Cells, cannot exclude HSIL): Changes that may suggest high-grade squamous intraepithelial lesion (HSIL).
3. Low-Grade Squamous Intraepithelial Lesion (LSIL):
   • Mildly abnormal changes, often associated with HPV infection.
4. High-Grade Squamous Intraepithelial Lesion (HSIL):
   • More severe abnormalities, higher risk of progression to cervical cancer.

Prevention of Cervical Cancer

Preventive measures focus on reducing the risk factors and early detection of precancerous changes through regular screening and vaccination.

1. Human Papillomavirus (HPV) Vaccination:
   • Vaccines: Gardasil, Gardasil 9, and Cervarix.
   • Target Population: Recommended for girls and boys starting at ages 11-12, but can be given as early as age 9 and up to age 45 in some cases.
   • Efficacy: Prevents infection with HPV types that cause the majority of cervical cancers and precancerous lesions.
2. Regular Cervical Screening:
   • Pap Smear (Pap Test): Detects abnormal cells in the cervix. Recommended starting at age 21 and continuing every 3 years for women aged 21-29.
   • HPV Testing: Detects high-risk HPV types associated with cervical cancer. For women aged 30-65, co-testing with Pap smear and HPV testing every 5 years is recommended, or Pap smear alone every 3 years.
   • Follow-Up of Abnormal Results: Colposcopy and biopsy for further evaluation of abnormal screening results.
3. Lifestyle Modifications:
   • Safe Sexual Practices: Use of condoms and limiting the number of sexual partners to reduce HPV transmission.
   • Smoking Cessation: Smoking is a risk factor for cervical cancer, so quitting can reduce the risk.
4. Management of Precancerous Lesions:
   • Observation: CIN 1 often regresses spontaneously, so follow-up with repeat Pap smears or HPV testing may be recommended.
   • Treatment:
     • Cryotherapy: Freezing abnormal cells.
     • Laser Therapy: Using laser to remove abnormal tissue.
     • Loop Electrosurgical Excision Procedure (LEEP): Removing abnormal tissue using a wire loop heated by electric current.
     • Conization: Surgical removal of a cone-shaped piece of tissue from the cervix for more severe dysplasia.
5. Education and Awareness:
   • Patient Education: Informing women about the importance of regular screening, vaccination, and safe sexual practices.
   • Community Programs: Public health initiatives to increase awareness and access to cervical cancer prevention services.

3. Tubal Abortion: Clinic, Diagnosis, and Treatment

Answer: Tubal abortion, also known as ectopic pregnancy, is a pregnancy that develops outside the uterus, typically in the fallopian tube.

• Clinic:
  • Abnormal vaginal bleeding
  • Pelvic pain, often severe and sudden
  • Abdominal tenderness
  • Weakness, dizziness, or fainting
  • Shoulder pain (due to blood accumulation under the diaphragm)
• Diagnosis:
  • Transvaginal ultrasound (TVUS)
  • Serial beta-hCG measurements
  • Laparoscopy or hysteroscopy (if necessary)
• Treatment:
  • Medical management (methotrexate) for early, stable ectopic pregnancies
  • Surgical management (laparoscopy or laparotomy) for ruptured or unstable ectopic pregnancies
  • Salpingectomy or salpingostomy (removing or opening the affected fallopian tube)
• Differential diagnosis:
  • Miscarriage
  • Ovarian torsion
  • Ruptured ovarian cyst
  • Endometriosis
  • Appendicitis
  • Kidney stone
  • Diverticulitis

EXAMINATION TICKET 3

1. Fetal Birth Biomechanism in Occipital Presentation

Answer:

Biomechanism of Fetal Birth in Occipital Presentation

The occipital presentation, also known as the vertex or cephalic presentation, is the most common and favorable position for childbirth, where the baby’s head is positioned down in the pelvis, and the occiput (back of the head) leads the way through the birth canal. The biomechanical process of labor and delivery in this presentation involves several coordinated movements of the fetus, known as the “mechanisms of labor.” These mechanisms facilitate the passage of the baby through the maternal pelvis. The key steps are:

1. Engagement
   • Definition: The fetal head enters the pelvic inlet. The widest part of the fetal head (biparietal diameter) aligns with the widest part of the pelvic inlet.
   • Significance: This indicates the baby has started its descent into the birth canal.
2. Descent
   • Definition: The continuous downward movement of the fetal head through the pelvis.
   • Forces Involved: Uterine contractions, maternal pushing efforts, and gravity.
   • Significance: Descent occurs throughout labor and is necessary for the fetus to progress through the pelvis.
3. Flexion
   • Definition: The fetal chin tucks toward the chest.
   • Biomechanics: This movement decreases the presenting diameter of the fetal head from the occipitofrontal (approximately 11.5 cm) to the suboccipitobregmatic (approximately 9.5 cm).
   • Significance: Flexion allows the smallest possible diameter of the fetal head to present to the birth canal, facilitating easier passage.
4. Internal Rotation
   • Definition: The fetal head rotates to align with the anteroposterior diameter of the pelvis.
   • Biomechanics: Typically, the occiput rotates anteriorly toward the maternal symphysis pubis (occiput anterior position).
   • Significance: This rotation aligns the fetal head with the longest diameter of the maternal pelvis, easing its passage through the mid-pelvis.
5. Extension
   • Definition: As the head reaches the perineum, it extends to pass under the pubic arch.
   • Biomechanics: The occiput, followed by the vertex, brow, and face, emerges over the perineum.
   • Significance: This movement allows the fetal head to negotiate the curve of the birth canal and be born.
6. Restitution (External Rotation)
   • Definition: After the head is born, it realigns with the shoulders.
   • Biomechanics: The head rotates back to its original position relative to the shoulders.
   • Significance: This movement facilitates the alignment of the shoulders with the anteroposterior diameter of the pelvic outlet.
7. Expulsion
   • Definition: Delivery of the fetal body following the birth of the head.
   • Biomechanics: The anterior shoulder slips under the pubic arch, followed by the posterior shoulder and the rest of the body.
   • Significance: Complete delivery of the baby.

2. Ovarian Tumors: Classification

Answer: Ovarian tumors encompass a broad spectrum of neoplastic growths originating from different cell types within the ovary. They are classified based on their histological origin and behavior (benign, borderline, or malignant). The main categories include epithelial tumors, germ cell tumors, sex cord-stromal tumors, and metastatic tumors.

1. Epithelial Tumors: These are the most common ovarian tumors, arising from the surface epithelium or lining cells of the ovary. They are further subdivided into several types based on the histological features.
   • Serous Tumors:
     • Benign (Serous Cystadenoma): Fluid-filled cystic structures.
     • Borderline (Serous Borderline Tumor): Atypical epithelial proliferation without stromal invasion.
     • Malignant (Serous Carcinoma): Invasive epithelial cells with varying degrees of differentiation.

EXAMINATION ticket – 4

1. Obstetrics Forceps: Indications, Conditions, Techniques

Answer:Obstetric forceps are surgical instruments used in childbirth to assist with the delivery of the baby’s head when certain complications arise. Here’s a breakdown:

Indications:

1. Prolonged second stage of labor (failure to progress).
2. Maternal exhaustion.
3. Fetal distress.
4. Certain maternal medical conditions that warrant a quicker delivery.
5. Malpresentation of the fetal head.
6. Inability to push effectively due to epidural anesthesia.

Conditions:

1. Cephalopelvic disproportion (when the baby’s head is too large to fit through the mother’s pelvis).
2. Fetal distress or abnormal fetal heart rate patterns.
3. Maternal exhaustion or inability to push effectively.
4. Malposition of the baby’s head (e.g., occiput posterior).
5. Maternal medical conditions that necessitate a quicker delivery.
6. Need for expediting delivery in certain situations, such as in cases of placental abruption or umbilical cord prolapse.

Techniques for obstetrics forceps:

• Assisted vaginal delivery:
  • Sterilize and lubricate the forceps, position the mother in lithotomy position, insert the forceps into the vagina and position on either side of the fetal head, lock the blades and apply gentle traction to guide the fetal head through the birth canal.
• Placental delivery:
  • Sterilize and lubricate the forceps, insert into the uterus through the vagina and position on the edge of the placenta, lock the blades and apply gentle traction to remove the placenta.
• Vaginal surgery:
  • Sterilize and lubricate the forceps, insert into the vagina and position on the tissue that needs to be held or manipulated, lock the blades and gently pull or retract the tissue to provide better access for the surgeon.
• Cesarean section:
  • Sterilize and lubricate the forceps, insert through the abdominal incision and position on the uterus, lock the blades and gently pull the uterus up through the incision, making it easier for the surgeon to access the fetus.

2. Women’s Counseling: Role in Gynecological Health

Answer: Women’s counseling plays a significant role in the prevention, diagnosis, and treatment of gynecological diseases by providing education, support, and guidance. Here’s how:

Prevention:

1. Education: Counseling sessions educate women about preventive measures such as regular screenings (Pap smears, mammograms), vaccinations (HPV vaccine), and lifestyle factors (healthy diet, exercise) to reduce the risk of gynecological diseases.
2. Risk assessment: Counselors assess individual risk factors such as family history, reproductive health, and lifestyle choices to tailor preventive strategies.
3. Contraception: Counseling helps women choose and understand the appropriate contraceptive methods, reducing the risk of unintended pregnancies and related complications.

Diagnosis:

1. Symptom recognition: Counseling encourages women to recognize and report symptoms of gynecological diseases promptly, facilitating early diagnosis and treatment.
2. Screening guidance: Counselors provide information on screening tests and their importance, encouraging regular screenings for early detection of conditions like cervical cancer, breast cancer, and sexually transmitted infections.
3. Referral to healthcare providers: When necessary, counselors refer women to healthcare providers for further evaluation and diagnostic testing based on their symptoms or risk factors.

Treatment:

1. Decision-making support: Counseling helps women understand treatment options, potential side effects, and their implications, empowering them to make informed decisions about their healthcare.
2. Emotional support: Coping with a gynecological disease diagnosis can be challenging. Counseling provides emotional support, coping strategies, and resources to help women navigate their journey through diagnosis and treatment.
3. Compliance and follow-up: Counselors encourage adherence to treatment plans and follow-up appointments, ensuring optimal outcomes and monitoring for any complications or recurrence of the disease.

Overall, women’s counseling serves as a crucial component of holistic gynecological care, addressing not only the physical aspects of disease prevention and treatment but also the emotional and psychological well-being of women.

3. Rupture of the Tube: Urgent Help

Answer: Rupture of the tube (tubal rupture) is a medical emergency!

Symptoms:

• Severe abdominal pain
• Vaginal bleeding or spotting
• Fainting or dizziness
• Abdominal tenderness or guarding
• Pelvic pain or cramping
• Fever or chills

Here are the steps for emergency care:

1. Call emergency services or go to the emergency room immediately.
2. Provide symptoms and medical history to the healthcare provider.

Emergency Room Treatment:

On arrival at the hospital, you will undergo rapid assessment and diagnostics, including:

• Pelvic examination: To check for tenderness and masses.
• Ultrasound: To locate the pregnancy and assess for internal bleeding.
• Blood tests: To check for levels of the pregnancy hormone (hCG) and assess for anemia or blood loss.

Surgical Intervention:

Surgery is typically required to manage a ruptured fallopian tube. The procedures include:

Laparoscopy: Minimally invasive surgery to repair or remove the damaged tube.

Laparotomy: An open surgical procedure if there is significant internal bleeding or if laparoscopy is not feasible

Pain management and blood transfusions may be necessary depending on the extent of blood loss.

EXAMINATION ticket – 5

1.Acaesareansection.Indications,conditions, andtechniques.

Ans- A Caesarean section (C-section) is a surgical procedure used to deliver a baby through incisions made in the abdomen and uterus. It is performed when vaginal delivery would put the mother or baby at risk.

Indications

Maternal Indications:

Previous C-sections: Risk of uterine rupture from a previous scar.

Labor complications: Prolonged labor, failure to progress.

Maternal health issues: Conditions like hypertension, diabetes, or infections (e.g., HIV).

Placental issues: Placenta previa (placenta covering the cervix) or placental abruption (placenta detaching from the uterus).

Fetal indication

Fetal distress: Abnormal heart rate patterns indicating the baby is not getting enough oxygen.

Breech presentation: Baby is positioned feet or buttocks first.

Multiple pregnancies: Twins, triplets, etc., especially with non-optimal positioning.

Large baby: Suspected macrosomia (very large baby, often due to maternal diabetes).

Combined Indications:

Cephalopelvic disproportion: Baby’s head is too large to pass through the mother’s pelvis.

Infections: Active herpes infection or other infections that can be transmitted during vaginal birth.

Conditions:*

– Elective (planned)

– Emergency (can be subclassified into three categories based on urgency)

– Category 1 (immediate threat to the life of the woman or fetus)

– Category 2 (maternal or fetal compromise that is not immediately life-threatening)

– Category 3 (no maternal or fetal compromise but needs early delivery)

– Category 4 (elective – delivery timed to suit woman or staff)

 Techniques

Preoperative Preparation:

 Informed consent: Explanation of risks and benefits.

Preoperative assessments: Blood tests, monitoring of the baby’s heart rate.

Anesthesia: Typically a spinal block or epidural to numb the lower half of the body. General anesthesia is used in rare emergency situations.

Surgical Procedure:

Incisions:

Skin incision: Usually a horizontal (bikini line) incision above the pubic hairline. Sometimes a ver

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