Lecture on the forehead in obstetrics

2021-03-18 12:00 AM

But never forget that childbirth is very strenuous, requires great effort and close monitoring

General perception

The forehead is the part of the forehead presented to the upper waist. An intermediate person between the crown and the face, that is, the head is not well bowed and the head is not good.

The throne is rare. Rate 1/1000. The forehead only occurs during labor. If the forehead is still high, it can progress to bend more to turn into a crown or face up to become a face. If the crown is fixed, it is difficult to give birth, it is impossible to give birth to the lower line because the diameter of the throne is a magnet of 13.5 cm, it cannot pass the diagonal of the upper waist if the fetus is term. Leaning is only rare when the fetus is very small.

Diagnosis must be early and accurate for cesarean section to avoid complications for the fetus and mother.

Causes: There are favorable factors that cause the frontal crown during labor such as the uterus giving birth many times, the uterus deviating from the axis of the upper waist, flat pelvis, and fetal enlargement. So the forehead is more common in the womb than in the son.

Spawning mechanism

There are two different scenarios:

When the pregnancy is full term, normal weight, with clear diagnosis or suggestive signs of forehead, a cesarean section is required because the fetus cannot pass.

When preterm pregnancy, small fetus (twins), can give birth to the lower line, it is necessary to know the birth mechanism of the throne. But never forget that childbirth is very strenuous, requires great effort and close monitoring.

Tubes: The leaky diameters of the crown may be larger than the diameters of the upper waist, so fetal head must be deformed much, mold flexion, overlap, appear early serous tumor, asymmetrical leaks, long forehead in the groin. sacral also extending toward the back: either the head is bent more to allow the occipital mass to reach the posterior and the occipital mass, or the upturned head adds the front face mass base and the occipital mass behind. The tip passes through the horizontal or diagonal diameter. Slide the shape of an "S".

Down and turn: if possible, down and turn very slowly and difficult, the head is in the position of the guard. The face behind the hip joint, the upper jaw is fixed to the lower margin of the joint, the occipital is in the pit of the same pot. The first axis follows the anterior diameter after the lower waist, the fetus can easily get stuck under the hip joint.

Led: the head performs a series of movements that are close to the same occipital number, the head bows and then heads back.

Nasal right first, left posterior pelvis nose falls diagonally right diagonally.

The right pelvic tip is horizontal and the left pelvic tip is horizontal.

Diameter before and after upper waist is not used because it is too small compared to the diameter of the throne.

Differential diagnosis

Cap: never palpable posterior fontanelle on forehead. In the crown of sd, we see the posterior tip in the middle of the cervix, which is a well bowed crown.

The face: in the face, you can feel the joint line between the forehead bones, the fovea with two eye holes, the nostrils, the upper jaw, the mouth, the lower jaw (the horseshoe shape), the chin can determine the face, not palpable front joint.

Prognosis

The prognosis for mother and child depends on early or late diagnosis. If it is detected, surgery is timely, good prognosis for both mother and child. If detected late, managed not in time, the prognosis is bad, it can cause uterine rupture, which is life-threatening for both mother and child. If the lower line is born in the case of a small fetus, it can tear the vagina, episiotomy, rupture of the bladder, damage the rectum causing vaginal bladder fistula, rectal fistula. So to actively cut the episiotomy wide.

Treatment attitude

When the amniotic fluid is not broken, the throne is lanky, it is best to wait and watch. Absolutely not make the head better because it can easily break the amniotic fluid, break the vegetable cord.

If the amniotic fluid is broken, it must be transferred to the caesarean section immediately

Note that all definitive diagnosis of fixed frontal crown requires absolute cesarean section (except for very small pregnancy). One point to note is that when the forehead is stuck in the subframe, caesarean section, taking the head up is not easy. Therefore, it is necessary to closely monitor labor so that complications of pregnancy stuck in the subframe, uterus spasticity, hypertonia, and large serous tumour are mistakenly mistaken for the birth of the fetus, leading to rupture of the uterus. , acute fetal failure and fetal death.

If in the case of fetal death, there is no sign of uterine rupture and rupture of the uterus, the uterus is open enough to destroy the vaginal canal by poking the brain, holding the fetus out of the skull. If there is a threat of uterine rupture, even if the fetus dies, it must take a pregnancy, then depending on the damage in the uterus, decide to preserve or remove the uterus, pay attention to check the organs in the abdomen, especially the bladder is damaged or is not.