Submitted by -Swati Verma 

GTG Perineal tears-

1. Overall incidence- 2.9% (0-8%)::::6.1% in primi, 1.7% in multi

2. Rectal buttonhole tear- tear involving rectal mucosa with intact anal sphincter complex; if not repaired—->rectovag fistula

3. Mediolateral episiotomy preferred —>angle 60 degrees away from midline (post delivery angle of 45degrees )

4. For IAS and partial thickness EAS—->end to end technique

For full thickness EAS tear—->overlap or end to end technique

5. Anorectal mucosa——> 3-0 polyglactin

EAS/IAS muscle——> monofilament 3-0 PDS or modern braided (2-0 polyglactin)

Submitted by – Shirisha

Severe maternal morbidity rate-6/1000

Maternal mortality rate-14/100000 births

Rate of maternal collapse=0.14-6/1000 births

MCC of maternal collapse-haemorrhage

MCC of direct maternal death-vte

MCC overall cause of maternal death- cardiac

Major hge incidence-3.7/1000 maternities

incidence of AFE-2/100000 maternities

Perinatal mortality with AFE-135/1000 total births

Incidence of anaphylaxis-3-10/1000


Uterine blood flow 10%of total circulation at term

Plasma volume increases by 50%

Heart rate increases by 15-20bpm

Cardiac output increases by 40% and is decreased by 30-40% by the gravid uterus

Arterial bp decreases by 10-15mmHg

O2 consumption increases by 20%

Residual capacity decreases by 25%

15° lateral tilt to the left

Chest compression to ventilation ratio 30:2 (intubated- desynchronised with compression-100/min n ventilation 10/min)

Perimortem cs to be done if no response to correct CPR in 4min and to be done within 5 min of collapse

Irreversible brain damage in 4-6min

Sepsis care bundle read plz

Intralipid 20% rescue dose read plz

Anaphylaxis- 500microgm (0.5ml 1:1000 im adrenaline)

50microgm (0.5ml 1:10000 adrenaline slow iv in experienced hands)

Adjuvants- chlorpheniramine 10mg and hydrocortisone 200mg Im or slow iv

Submitted by – Shirisha

#Shoulder dystocia-


Incidence of pph-11%

3/4 degree perineal tear-3.8%


Less than 10%BPI results in permanent dysfunction

46% injuries are d/t substandard care

Risk assessment is predictive in 16% cases

48% of SD occurs in infants with BW<4kg

Infants of mothers with GDM -2-4FOLD rise

Recurrence rates for SD-1-25%

humerus# after delivery of posterior arm=2-12%

Success rates of all fours-83%