CASE PRESENTATION VBAC1111111111111.pptx

GOOD VBAC

1. VAGINAL BIRTH AFTER CAESARIAN SECTION (VBAC) PRESENTED BY DR. MOHAMMAD FARDEEN SHIHAB INTERN DOCTOR DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY UTTARA ADHUNIK MEDICAL COLLEGE AND HOSPITAL 20XX Pitch Deck

2. 20XX Pitch Deck 2 Mrs. Shopna Akhter, 25 year old lady hailing from Tongi , Gazipur , was admitted to the Department of Obstetrics and Gynaecology , Uttara Adhunik Medical College and Hospital at her 37 weeks of gestation presenting with the complaints of : History of amenorrhea for 37 weeks Lower abdominal pain for 1 day Previous history of 1 Lower Segment Caesarian Section (LSCS) . .

3. 20XX Pitch Deck 3 According to the statement of the patient, she was a regularly menstruating women with average flow and duration . She was amenorrhoeic for 37 weeks and was under regular antenatal checkup. Her L.M.P. was on 30.07.2022 and accordingly her E.D.D was 07.05.2023 which was confirmed by early ultrasonogram .

4. 20XX Pitch Deck 4 Her pregnancy was uneventful till the 37 th week of gestation after which she experienced pain in lower abdomen for one day. The pain came intermittently, at first at an interval of 2 hours and then more frequently at an interval of 1 hour . The pain was gradually increasing in intensity and frequency, and radiating towards the thigh from the back and associated with hardening of the uterus. She had no history of increased frequency or burning sensation during micturition. She was then admitted to this hospital for further management

5. 20XX Pitch Deck 5 According to her obstetric history, she was married for 9 years, mother of one child delivered by Lower Segment Caesarian section with an incidence of 1 spontaneous abortion two years back. Age of last child was eight years. She gave no history of any medical disorders complicating her pregnancy and reported no history of trauma to the abdomen. Her bowel and bladder habits were normal.

6. CLINICAL EXAMINATION 20XX Pitch Deck 6 With due consent and maintaining adequate privacy, clinical examination was conducted on 18.3.2023. GENERAL EXAMINATION: On general examination, she looked anxious but cooperative with an average body built . She had no anaemia , jaundice or oedema . Her thyroid gland was not enlarged nor palpable. Her vitals were within normal limits, including: Blood Pressure : 120/80mmHg Pulse: 84 beats/min Respiratory Rate: 15 breaths per minute Temperature of 98.4 ° F.

7. SYSTEMIC EXAMINATION 20XX 7 Examination of both breasts showed pregnancy changes. Examination of cardiorespiratory system and other systemic examinations showed no significant findings.

8. PER ABDOMINAL EXAMINATION 20XX Pitch Deck 8 Per abdominal examination revealed : ON INSPECTION: A uniformly enlarged abdomen with a transverse scar on the lower abdomen. ON PALPATION: There was no localised tenderness over the abdomen . Symphysio -fundal height (SFH) was 36cm corresponding with the age of gestation. Abdominal girth was 95cm. A single fetus with longitudinal lie, cephalic presentation Head was 2/5 th palpable and engaged. Amniotic fluid seemed to be adequate. ON AUSCULTATION: Fetal Heart rate was 130bpm and regular.

9. PER VAGINAL EXAMINATION 20XX Pitch Deck 9 On per vaginal examination: Pelvis was adequate. Cervix was soft , central and os was dilated at 5cm. Effacement was about 70% Station of head was 0. Presentation was cephalic. Membrane was intact.

10. DIAGNOSIS: 20XX Pitch Deck 10 3rd GRAVIDA P 1+1(ABORTION) 37 WEEKS OF PREGNANCY WITH LABOUR PAIN (1 ST STAGE OF LABOUR ) WITH PREVIOUS HISTORY OF 1 LSCS

11. INVESTIGATIONS 20XX 11 Her investigations revealed the following: Blood Grouping and Rh Typing (AB positive) Haemoglobin (dated 17.03.2023) : 11.5g/dl 3. Ultrasonography ( A single live pregnancy with cephalic presentation and longitudinal lie at 37 weeks of gestation weighing 2.6 kg) Other investigation findings were normal.

12. 20XX Pitch Deck 12 COUNSELLING Both the patient and her legal guardians were counselled about complications and consequences of VBAC. ASSURANCE MANAGEMENT

13. INFORMED WRITTEN CONSENT MANAGEMENT

14. 20XX Pitch Deck 14 REQUISITION FOR BLOOD TRANSFUSION WITH DONORS KEPT STANDBY INVOLVEMENT OF MULTIDISCIPLINARY APRROACH INCLUDING CONSULTANT OBSTETRICIAN , SENIOR ANAESTHETIST AND NEONATOLOGIST FOR ANY FUTURE INTERVENTION OPERATION THEATER WAS KEPT READY WITH NICU SUPPORT FOR PROMPT MANAGEMENT OF ANY POSSIBLE SURGICAL INTERVENTION MANAGEMENT

15. 20XX Pitch Deck 15 After taking due consent, monitoring of the progress of labour commenced with the aid of a PARTOGRAPH. ON ADMISSION, Fetal Heart Rate was 130bpm Liquor was clear Moulding was absent Cervical dilatation was 5cm Cervical effcaement 70% 3 uterine contractions in 10 minutes extending between 20 to 40s Blood pressure 120/80 mmHg Pulse was 84 bpm By 2pm, uterine contractions were optimum and cervix was dilated at 9cm.

16. PARTOGRAPH USED TO MONITOR PROGRESS OF LABOUR 20XX Pitch Deck 16 AT 10 A.M: FHR: 130 bpm Amniotic Fluid :Clear Moulding : Negative Cervical dilatation : 5 cm at 10 a.m. 9cm at 2 p.m. 10cm at 3 p.m. Uterine contraction: 3 in 10 mins extending from 20 to 40s till 11 30 a.m 4 in 10 mins extending from 20 to 40s till 1 p.m. 4 in 10 mins extending for more than 40s after 1 pm till delivery Blood pressure :120/80mmHg Pulse:84 bpm, Urine Output: 200 ml

17. 20XX Pitch Deck 17 Every 4 hours: Per vaginal examination was conducted Every 30 minutes: Maternal Vitals Fetal Heart Rate Number of Uterine Contractions Signs of scar tenderness

18. After approximately 5 hours, a healthy male baby was delivered per vaginally. Active management of third stage of labour (AMTSL) was conducted diligently . After ensuring a well contracted uterus and optimum uterine contour, patient and her baby were both monitored for one hour in the four stage and any post-partum haemorrhage was excluded. The baby received immediate primary care under the watchful eyes of the paediatrician . BABY NOTE: Sex: Male Weight:2.7 kg APGAR SCORE: 8/10 in 1 st minute 9/10 in 5 th minute 20XX

19. THANK YOU FIG : Shopna Akhter following successful VBAC at Uttara Adhunik Medical College and Hospital.