1.7 - Operative Delivery Flashcards
Give the 3 types of operative delivery
Ventouse/vacuum/kiwi
Forceps delivery
C-section (elective or emergency)
How does epidural affect the management of 2nd stage of labour
Although it provides pain relief, it may also be harder for the mother to notice contractions and push accordingly.
The main significance is that we allow an hour of passive descent during 2nd stage of labour to reduce maternal exhaustion
Also extra note, midwives would have to monitor mother’s vitals and foetal CTG every 10 minutes
What is considered prolonged 2nd stage of labour?
First we need to distinguish if the patient is
If epidural: Primup or a multip. Next we need to determine if the patient is on epidural or not
No Epidural:
Primup 2 hours
Multip 1 hour
Epidural: includes 1 hour of passive descent
Primup 3 hours
Multip 2 hours
What maternal conditions necessitate the avoidance of pushing?
Cardiac disease
Severe HTN
Give 3 indications for operative delivery
Failure to advance in 2nd stage
Suspected foetal compromise
Maternal conditions that necessitate avoidance of pushing e.g. Cardiac disease or severe HTN
Give 5 pre-requisites to operative delivery (excluding C-section)
What is an additional pre-requisite for Forceps delivery?
Station = 0
Cephalic presentation(+longitudinal lie)
Cervix fully dilated at 10cm
Gestation >34 weeks
Must include everything above this
Empty bladder
Appropriate analgesia
personelle present skilled at operative delivery and neonatal resus
Forceps: + Sagittal suture must be midline (ears)
Which method of operative delivery has the highest success rate (excluding C-section)
Forceps
Which method of operative delivery is quicker?
Forceps
What are the main 2 advantages of using ventouse over forceps delivery?
Reduced maternal complications
Reduced need for analgesia
What is an episiotomy?
What are the different types? Which is most commonly used?
Give 3 indications?
Surgical procedure in which the perineum is cut with surgical scissors to widen the soft-tissue diameter of the Introitus (External opening of the vagina, +/- 1cm from hymenal remnant) to prevent perineal tears. This is conducted with pudendal nerve injection with local anaesthetic
Mediolateral is the most common 5 or 7 o clock. Others include median and lateral
Indications:
1) Rigid perineum
2) Perineal tear imminent (prevents 3rd and 4th degree tears)
3) Shoulder dystocia management
Please grade perineal tears
1st degree = vulval skin or vaginal epithelium only
2nd degree = Perineal muscles not involving anal sphincter (equivalent to an episiotomy hence why it is done with forceps delivery to prevent 3rd and 4th degree)
3rd degree = Perineum + involves anal sphincter (3a = <50%, 3b = >50%, 3c = Internal anal sphincter)
4th degree - Anal sphincter + Rectal Mucosa
Neville Barnes Forceps is the most commonly used forceps. It is a non-rotational one. State the complications associated with it.
Fetal complications:
Facial lacerations (may also cause skull fractures)
Facial nerve compression!!
Maternal complications
Much higher risk of 3rd or 4th degree perineal tears
Urine retention
Pelvic organ prolapse
Requires episiotomy
+ failure
Ventouse is a suction cup applied to the foetal scalp and then traction force is applied. Where exactly should you place this suction cup?
2cm anterior to the posterior fontanelle
Remember the foetus should be looking at the mother’s back so during descent its face should be down and back of occiput up (occiput-anterior). => 2cm down from the posterior fontanelle
State 5 complications of Ventouse delivery
Maternal: 3rd degree perineal tears but much less common than forceps
Foetal complications:
Caput succedeneum, Cephalohematoma leading to secondary jaundice
Retinal hemorrhage
Scalp lacerations (much less common than forceps)
poor feeding
+ Failure
In the case that youve tried one operative method of delivery, how will you escalate from there?
Call for help
Try combined assisted delivery (use both)
emergency C-section
