13. Operative Delivery Flashcards
Operative vaginal delivery using vacuum extractor or forceps should only be performed if there is immediate ability to do what?
Perform C-section in case the procedure fails!
What is operative delivery?
Not spontaneous delivary via vaginal (forceps or vacuum) or c-section.
When is operative vaginal delivery CI?
- Fetal head is not engaged
- Position of fetal head is unknown
- Fetus has bone dimeralization condition (osteogenesis imperfecta)
- Bleeding disorder
What are maternal indications for use of operative vaginal delivery?
- Mother is exhausted/lack of expulsive effort
- Inability to have expulsive effort: spinal cord injuries or neuromuscular disorders (i.e., MS)
- Needs to avoid maternal expulsive efforts: certain cardiac conditions (i.e., aortic stenosis) or CVD (i.e., aneurysm or brain tumor)
What is the fetal indication for performing operative vaginal delivery?
Non-reassuring fetal status (i.e., bradycardia, repetitive HR decelerations)
Prolonged 2nd stage of labor is a CI for operative vaginal delivery.
What qualifies as prolonged 2nd stage of labor in a nulliparous vs. multiparous W?
- Nulliparous: >2 hours w/o regional anesthesia or >3 hourswith
- Multiparous: >1 hour w/o regional anesthesia or >2 hourswith
What must mom do before operative vaginal delivery?
- Adequate analgesia
- Lithotomy position
- Bladder empty
- Verbal or written consent
5 Fetal Criteria must be met if you are to perform Operative Vaginal Delivery
- Vertex presentation
- Fetal head MUST be engaged (0 station)
- Must know position of fetal head w/ certainty
- Station of the fetal head must be >+2
- Fetal weight was estimated
3 uteroplacental criteria for Operative Vaginal Delivery
- Cervix fully dilated
- Membranes ruptured
- NO placenta previa
What are 5 maternal complications which can occur with forceps delivery?
- Laceration of the vagina/cervix
- Injure the urethra, bladder and uterus
- Episiotomy extension
- Pelvic hematomas
What are 6 fetal complications which can occur with forceps delivery?
- Minor facial lacerations
- Forceps marks
- Facial and brachial plexus injuries
- Neuro: Skull fractures, Intracranial hemorrhage, Seizures
When is low operative vaginal delivery?
- Leading point of the fetal head is at +2 station and NOT on the pelvic floor (is rotational/non-rotational)
When is a midpelvis and high forceps operative vaginal delivery performed?
- Fetal skull is above +2 station, but NOT EVER indicated today.
When should you NOT APPLY forceps?
- If not positive of position
- If they dont articulate easily, reapply. If they still don’t articulate well, don’t apply.
ALWAYS check to make sure that no ______________ are caught in the forceps.
no vaginal tissue or cervix
What should ALWAYS be done before applying traction?
- Blade should fit the head evenly
- Should lie against the fetal head so that they cover the space in between the orbit and ears
How is traction applied when using forceps to deliver?
Plane of least resistance and follow the pelvic curve. If not easy, STOP.
Indications for Vacuum Assisted Vaginal Delivery
- Indications
- Advantage
- Indications: Same as forceps
- Advantage: Delivery can be acheived with little maternal analgesia.
4 CI to using Vacuum Assisted Vaginal Delivery
- Gestational age < 34 wks
- Breech
- Suspected fetal coagulation disorder
- Suspected fetal macrosomia
Where should the cup of a vacuum assisted vaginal device be placed on the infants head?
2cm anterior to the posterior fontanelle over the sagittal suture.
How do the complications of using vacuum assisted vaginal extractors compare to that of forceps?
- More failed deliveries with vacuums
- Fewer perineal injuries to mother
- ↑ incidence of fetal caphalohematoma, scalp lacerations and bruising
3 things to check for during vacuum extraction
- No maternal tissue is trapped in cup
- Cup should be midline of the sagittal suture
- Vacuum port of the suction cup should point TOWARD the occipiut
Vacuum extractor
- Release the suction between _____
- No more than ____ pop offs
- Should not be applied for more than ____ minutes
- release between contractions
- 2
- 20 minutes
What are 4 maternal-fetal indications for doing a C-section?
- Cephalopelvic disproportion (kids too big)
- Failure to progress
- Abruption of placenta/placenta previa (other placental problems)
What are 6 maternal indications for C-section?
- Obstructive benign and malignant tumors
- Large vuvlar condyloma
- Abdominal cervial cerclage
- Prior vaginal colporrhaphy
- Conjoined twins
- Maternal request
What are the 6 fetal indications for a C-section?
- Non-reassuring fetal HR
- Very LBW (less than 1500gms)
- Active HSV infection
- Immune thrombocytopenia purpura
- Breech/transverse
- Congenital anomalies
7 Intraoperative C-section Complications?
- Lacerate uterine artery
- Bladder injuries
- Ureteral injuries
- GI tract injury
- Uterine atony
- Placenta accreta
- Cesarean hysterectomy
What are 6 post-op complications of C-section?
- Endomyometritis (infection of uterus)
- Wound complications: infection, separation, dehiscence
- Urinary complications (retention, infection)
- GI complications (ileus, diarrhea)
- Thromboembolic disorders (pulmonary emboli/DVT)
- Septic pelvic thrombophlebitis (most commonly of ovarian v.)
