In aeep transverse arrest inu delivery of baby is conducted by :: (A) Cesarean section, (B) Vacuum extraction, (C) Keilland forcep and Manual rotation and forcep delivery both, (D) All
Answer is D. Ans. is a, b, c and d i.e. Cesarean section; Vaccum extraction; Keilland forcep; and Manual rotation and forcep delivery In case of occipto posterior position if paial anterior rotation occurs the head is arrested with the sagittal suture in the transverse diameter at the level of the ischial spines, after full dilatation of the cervix in spite of good uterine contractions. This condition is called as Deep Transverse Arrest. It occurs more commonly in android pelvis. Ventouse Ideal in all cases Manual rotation & If the obstetrician is well versed with this technique manual rotation followed by forceps application forceps application can be done Forceps rotation & Under general anaesthesia Keilland's forceps are used for rotation and delivery delivery in deep transverse arrest. Cesarean section If the pelvis is android or there is CPD, cesarean section should be done. In modern obstetrics, traumatic vaginal delivery causing intracranial hemorrhage is to be avoided at all costs and so there is increasing use of cesarean section for deep transverse arrest. Craniotomy If the baby is dead. Note : In most centres now a days, either cesarean section or vaccum extraction is performed, due to lack of experience in forceps rotation and manual rotation. It is extremely impoant to remember that if vaccum or forceps fails, no attempt should be made to persist with vaginal delivery. The procedure should be abandoned and immediate cesarean section undeaken. In late and neglected cases if the fetus is dead, craniotomy is an option in experienced hands. However, now days most obstetricians would prefer to perform cesarean section in cases of obstructed labour, even when the fetus is dead.