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Types of Birthing

Spontaneous Vaginal delivery

It is the most common type of birth. Presenting Part gets engaged in birth cannel 10 days prior to development of labor pain. First False labor pain start followed by true labor pains. These are identified as regular lower abdominal pain from back, radiating to things associated with excessive vaginal discharge called show which happens due to simultaneous opening of mouth of uterus. Contractions become more frequent and more sever with progress of labor. Spontaneous ruptures of membranes happen and water bag leaks and eventually parts start crowning on the perineum.

Push from above (Contraction), birth passage adequacy (no cephelopelic disproportion) and pull of presenting part at outlet results in spontaneous vaginal delivery.

While fibroids are common,they are not a typical cause for infertility, accounting for about 3% of reasons why a woman may not be able to have a child. The majority of women with uterine fibroids will have normal pregnancy outcomes. In cases of uterine fibroids with infertility, a fibroid is typically located in a sub mucosal position and it is thought that this location may interfere with the function of the lining and the ability of the embryo to implant. Also larger fibroids may distort or block the fallopian tubes.

Myomectomy is surgery to take out fibroid and preserve uterus.

Depending on the size, number and location of your fibroids, your surgeon may choose one of three surgical approach.

Abdominal myomectomy

In abdominal myomectomy (laparotomy), your surgeon makes an open abdominal incision to access your uterus and remove fibroids. Generally done for very large fibroids (more than 22 weeks size) where laparoscopic is not a right choice or patient who has multiple previous surgery and expected to have lots of adhesions. Your surgeon enters the pelvic cavity through one of two incisions:

• A horizontal bikini-line incision that runs about an inch (about 2.5 centimeters) above your pubic bone. This incision follows your natural skin lines, so it usually results in a thinner scar and causes less pain than a vertical incision does. It may be only 3 to 4 inches (8 to 10 centimeters), but may be much longer. Because it limits the surgeon’s access to your pelvic cavity, a bikini-line incision may not be appropriate if you have a large fibroid.

• A vertical incision that starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone. This gives your surgeon greater access to your uterus than a horizontal incision does and it reduces bleeding. It’s rarely used, unless your uterus is so big that it extends up past your navel.

Laparoscopic or robotic myomectomy

In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions.

During laparoscopic myomectomy, your surgeon makes a small incision in or near your bellybutton. Co2 gas is introduced to elevate abdominal wall then laparoscope is introduced — a narrow tube fitted with a camera — into your abdomen. Surgery is performed with instruments inserted through other small incisions in your abdominal wall. During robotic myomectomy, instruments are inserted through similar small incisions, and the surgeon controls movement of instruments from a separate console, but surgery essentially remains same.

Incision is made on uterine surface, fibroid is enucleated from the surrounding muscles; the dead space created is approximated with multiple sutures, surface of uterus wall is then covered with adhesion barrier material.

Fibroid is cut into smaller pieces and removed through these small incisions in the abdominal wall.

Laparoscopic and robotic surgery use smaller incisions than a laparotomy does. This means you may have less pain, lose less blood and return to normal activities more quickly than with a laparotomy. Uterine size and fibroid number and location are factors that determines length of surgery.

Hysteroscopic myomectomy

To treat fibroids that bulge significantly into your uterine cavity (submucosal fibroids), your surgeon may suggest a hysteroscopic myomectomy. Surgeon inserts a small, lighted instrument — called a resectoscope because it cuts (resects) tissue using electricity or a laser beam — through your vagina and cervix and into your uterus. A clear liquid, usually a sterile salt solution, is inserted into your uterus to expand your uterine cavity and allow examination of the uterine walls. Using the resectoscope, your surgeon then shaves pieces from the fibroid until it aligns with the surface of your uterine cavity. The removed tissue washes out with the clear liquid that’s used to expand your uterus during the procedure. Rarely, surgeons also use a laparoscope inserted through a small incision in your abdomen to view the pelvic organs and monitor the outside of the uterus during a complicated hysteroscopic myomectomy.

When you go home

At discharge from the hospital, your doctor prescribes oral pain medication along with antibiotics.

You may have to avoid certain activities, such as driving, lifting heavy objects, climbing stairs or exercising vigorously until you recover. Also, your doctor may advise that you not use tampons or have sexual intercourse during recovery. You can expect some vaginal spotting or staining for a few days up to six weeks, depending on the type of procedure you’ve had. Gas introduced in the abdomen takes 3-4 days to dissolve and come out, till then you can experience shoulder pain in upright position as it elevate the diaphragm

• Abdominal myomectomy recovery typically takes four to six weeks.

• Laparoscopic or robotic myomectomy recovery typically takes two to three weeks.

• Hysteroscopic myomectomy recovery typically takes less than a week.

Advantages of Laparoscopic Myomectomy surgery

• Less pain post-operatively

• Smaller cuts (only 5mm)

• Faster recovery and discharge from hospital

• Quicker return to normal activity and lifestyle

Risks of myomectomy include:

• Excessive blood loss. Many women already have low blood counts (anemia) due to heavy menstrual bleeding, and need for blood transfusions.

• Scar tissue. … in uterine wall is generally stronger in open surgery as compared to laparoscopy.

• Rare chance of hysterectomy…. Generally patients with multiple fibroids who although insist on retaining uterus should know about it.