17: Operative Delivery Flashcards
Operative vaginal delivery
Forceps assisted or vacuum extracted
Maternal indications for operative vaginal delivery
Exhaustion/lack of effort, inability to have expulsive effort (spinal cord injuries, neuromuscular disorders), need to avoid maternal expulsive effort (cardiac conditions, cerebrovascular diseases), prolonged 2nd stage labor
Fetal indications for operative vaginal delivery
Non-reassuring fetal status (bradycardia, repetitive decels)
Outlet operative vaginal delivery
Scalp visible at introitus, fetal skull at pelvic floor, fetal head in perineum, rotation does not exceed 45 degrees
Low operative vaginal delivery
Leading point of fetal head at +2 station or more, not on pelvic floor
Midpelvis and high forceps
Fetal skull is above +2 station, NOT INDICATED TODAY
Complications of forceps delivery
Maternal: lacerations, episiotomy extension, pelvic hematomas, urethral/bladder injuries
Fetal: minor facial laceration, forceps marks, nerve injuries, cephalohematomas, skull fx, intracranial hemorrhage
Advantage of vacuum assisted delivery
Can be achieved with little maternal analgesia
Contraindications to vacuum assisted delivery
Less than 34 wks gestation, suspected fetal coag disorder, suspected macrosomia, breech presentation
Correct placement of vacuum cup
Midline of sagittal suture near posterior fontanelle
Compare complications of vacuum assisted delivery to forceps assisted delivery
More failed deliveries with vacuums, fewer perineal injuries, increased incidence fetal cephalohematoma, more scalp lacerations/bruising
Indications for C-section
Non-reassuring FHR, breech/transverse presentation, low birth weight, active HSV, congenital anomalies, cephalopelvic disproportion, failure to progress labor, placental abruption, placenta previa, maternal tumors and warts, conjoined twins, etc.
Complications of C-section
Uterine artery laceration, bladder and ureteral injury, GI tract injury, uterine atony, hysterectomy
