"Vacuum-assisted delivery is a type of operative delivery. We use a vacuum in the second stage of labor whenever there is a prolonged second stage whenever there's fetal distress on the second stage or to cut down the second stage of labor in case the mother has a heart disease or severe anemia or the mother has a scar on the uterus. So these are very common indications where we use the vacuum. It is pretty safe with the advanced silicon cups vacuum is pretty safe for both the mother and the fetus if done under proper precautions. So the maternal complications could be perineal tears if episiotomies are not given properly there could be urinary retention, prolonged pain at the perineum and there could be bleeding. For the baby, the baby has a much larger exaggerated caput which is just a fluid accumulation under the scalp but which resolves spontaneously. There could be little more serious issues like capid oxum where there is a hematoma between the scalp and skull. So in these cases because of the hematoma, the baby can have long jaundice and also pain and there could be other infrequent but still very serious complications like you know hemorrhage inside the brain. That's called intracranial hemorrhage or even retinal hemorrhage"

"The labour has two stages. The first and second stages are from the onset of regular uterine contractions to full dilation of the cervix, and the second stage is from Full dilation of the cervix to the expulsion of the baby. Usually, in the first pregnancy, the first stage lasts not more than 24 hours. The second stage lasts not more than 2 hours without anaesthesia and not more than 3 hours with anaesthesia in a second pregnancy, so the first stage of labour does not last more than 10 to 14 hours, and the second stage of labour does not last more than 1 hour without anaesthesia and two hours with anaesthesia. So prolonged labour is when this period of the above has crossed, and still, the patient has not delivered. So, the causes of protracted labour could be a big baby and inefficient uterine contractions. The incidence of prolonged labour is around 8 to 10%. The leading causes are inefficient uterine contractions, big babies, and maternal obesity. The mental effects of protracted labour are that she can have postpartum haemorrhage. She can have maternal exhaustion, urinary retention, and so on. What are the fetal effects? Fetal effects could be due to prolonged labour. There could be fetal distress there could be birth asphyxia, and there could be shoulder dystocia. So how do we treat it? We need to correct the cause. The cause is most commonly inefficient uterine contractions. We give oxytocin inc, release the uterine contractions, and try to deliver the baby. If any of the measures fail, the last resort is to take up the patient for a C-section"

"After the delivery of the head, the shoulders are pulled gently downward. If this method fails to deliver the shoulders and if it requires extra manoeuvres to deliver the shoulders, then it's called shoulder dystocia. Once the head is delivered and if it slightly pulls back, it's called a turtle sign; then we have to suspect shoulder dystocia. It's a pretty rare condition. The risk factors are if the baby is more than 4 kilos. If the mother has diabetes, we can also be suspect. When there is a prolonged first stage of labour and maternal obesity but still shoulder dystocia can occur in any baby. Suppose there is a disproportion between the baby's weight. So, how do we manage regular shoulder dystocia? Drills are conducted in our hospital, and all the labour room staff are trained to manage shoulder dystocia. The first thing to do is to call for help, and we have certain manoeuvres; we give suprapubic pressure, and we also flex the thigh against the abdomen so much that the opens widens and there is room for the shoulder to come out. So the last assort used in case of shoulder dystocia is either clavicle fracture in severe cases or, you know, pushing the head from below and taking it out through a C-section. How do we prevent shoulder dystocia? Prevention is by controlling diabetes. In case you're diagnosed with gestational diabetes and avoid excess maternal weight gain, regular excess exercise, proper diet, and follow the instructions given by your doctor."

"The umbilical cord is a lifeline for a baby inside the womb. It is a connection between the naval and the placenta. So the blood flows, and the baby gets oxygen and nutrients through the umbilical cord. The umbilical cord entangles are very common because the cord around the neck is very common. It's 30% of the normal deliveries have a cord around the neck cord around the, neck is not a contraindication for normal delivery. The thought of a cord around the neck is worrisome to many pregnant women in the later stages of pregnancy. Around the neck is usually harmless, and it is because of random movements of the baby, or it's because of excessively long cords, or even because of excessive liquor around the baby. It is harmless, and it does not pose any problem for vaginal delivery. Cord entanglement around the other parts of the body only causes fetal distress. In the case of good uterine contractions, whenever the cord is compressed otherwise, cord entanglement, even around the other parts of the body around the trunk, is harmless. It doesn't matter whether it's a single loop of cord around the neck or, a double Loop or multiple loops. All patients can be delivered vaginally. What are the complications of cord entanglement that sometimes cause fetal distress? There is compression on the cord due to labour uterine contractions in cases of short cord, and a cord on the neck may prevent the baby's descent. Only in cases of fetal distress, but the patients have to be taken up for a C-section; otherwise, all patient's cords around the neck can be tried for vaginal delivery. There's no way to prevent cord entanglement. No sleeping positions which prevent cord entanglement are generally thought of as"

"Postpartum haemorrhage. It is still considered normal after the placenta delivery up to 500 ml. If bleeding is more than 500 mL, it is really serious and needs immediate intervention because it can cause severe shock and death. What are the causes of postpartum haemorrhage? The most common cause is defective uterine contractility. The uterus has to contract after the delivery of the placenta, which does not do that. The most common other causes are there could be cervical or vaginal tears or there could be bleeding disorders in the patient. So, what are the risk factors for postpartum haemorrhage? Whenever there are multiple pregnancies like twins wherever, there is a uterine distension, which happens in twins, which happens in excessive liquor, and which happens even in big babies. Whenever there are placental issues, whenever there are infections, whenever there is a prolonged labour. So these are the few conditions with risk factors where postpartum haemorrhage can happen. So how do we treat it? Antenatally, patients have to take iron supplements and make sure the haemoglobin is always above the normal level. 11 is considered to be the lower limit of normal. So, always above 11 or at least 12 is considered fine. And the second thing is if there are any bleeding disorders which are diagnosed in the patient or in the family, it has to be intimated to the doctor. When Postpartum Hemorrhage has been diagnosed in the OT. The whole team is being alerted. So, all management measures are done simultaneously. One person arranges for blood; one person starts another IV line. The patient is given oxygen and IV fluids. At the vaginal end doctor empties the bladder and checks the cause of any tears are there so that they can be sutured. Then, as I said, the most common cause is defective uterine contractility. The bimanual compression method and massage are done to contract the uterus, and simultaneously, there are a few medications, prostaglandins or ergot alkaloids, used to contract the uterus. If all the medical measures fail"

"Uterus rupture can happen during normal delivery. There are two situations where it can happen one is if there is a scar on the uterus like if there was a previous cesarean delivery where there was a hysterotomy that is a second-trimester abortion by opening the abdomen or if there was myomectomy. Myomectomy means the removal of fibroids and suturing of the fall of the uterus. The other situation where uterine rupture can happen is in obstructed labor which is very uncommon these days but in rural settings, it's still there where patients stay at home for days together in labor and go to the hospital at the last minute. So it can be prevented. We have to select the cases where we're giving vaginal birth after a cesarean or on a scarred uterus where there was a myomectomy or a hysterectomy done. We need to select the patients carefully we have certain indications where we select the patients like if the cesarean was done for a non-recurrent indication like malpresentation"