20. Operative Delivery Flashcards
Operative means not spontaneous- either vaginal: forceps or vacuum assisted or cesarean delivery. VAGINAL operative delivery is SAFE when the physician knows what hes doing, should only be performed is physician has the ability, contraindicated if fetal had is not engaged, position is unknown, bleeding disorder or if the baby has a bone?
demineralization condition (osteogenesis imperfecta)
Indications for operative vaginal delivery include maternal exhaustion, inability to have expulsive effort, spinal cord injury, NM do, need avoid maternal expulsive efforts such as cerebrovascular disease (aneurysm) or cardiac conditions like?
Aortic stenosis
Fetal indications for operative vaginal delivery is nonreassuring fetal status (bradycardia, reptitive HR decelerations), other indications include prolonged second stage of labor, nulliparous >2hrs without anethesia or >3hrs with, and mutiparous >1 hour without anethesia or?
> 2hrs with regional anesthesia
Prereqs for operative vaginal delivery include adequate analgesia, lithotomy postion, bladder empty, verbal consent, fetal criteria, vertex presention, fetal head engaged, fetal had position must be known, fetal weight estimated and station of the fetal head must be at?
> 2+
prereqs for operative vaginal delivery include cervix fully dilated, membranes ruptures, no placenta previa, experienced operator, capability to perform Csection if needed. What forceps are used for the breech position?
Piper forceps
Kielland for rotations OT to make OA
Outlet operative vaginal delivery means head is at pelvix floor, low operative vag delivery means leading point of head is 2+ but not on pelvic floor, midpelvis and high forceps operative vaginal delivery is when fetal skull is above 2+ but is not ever?
indicated today :) LOST ART
**Never use forceps for transverse presentation
If you DONT know position of fetal head, dont apply forceps, if they dont articulate easily, DONT apply, always check that tissues arent caught, check placement before traction- should lie on head so they cover space between orbits and ears, traction is applied in the plane of least?
resistance and if baby doesnt come then STOP
maternal complications of operative forceps delivery include laceration of vagina/cervix, episiotomy extension, pelvic hematomas, urethral and bladder injuries and uterine rupture.. Fetal: (less common) facial lacerations, forceps marks, facial/brachial plexus injuries, skull fractures, intracranial hemorrhages and seizures
MEOW
Vacuum vaginal delivery has same indications and requirements as forceps, advantage: delivery can be acieved with little* maternal analgesia. Contraindications include gestational age less than 34 weeks (use forceps!), suspected fetal coagulation disorder, fetal marcosomia and?
BREECH position (booty first)
Vacuum vaginal delivery applied to fetal head with mechanical pump 2cm Anterior to posterior fontanelle and centered over sagittal suture, steady traction, no rocking or torque on the device, incidence of serious complication is about?
5%
Vacuum vaginal delivery pearls are same as forceps, including releasing suction between contractions, no more than 2 ‘pop offs’, no torsion or twisting of device during use and should not be applied for more than how many minutes?
20 minutes
Vacuum vaginal delivery complications compared to forceps, include: more failed deliveries with vacuum (12% vs 7%), fewer perineal injuries, increased incidence of fetal cephalohematoma or intracranial hemorrhage, and there are more scalp?
lacerations and bruising
***ONLY USE one or the other, forceps or vacuum not both d/t INCREASED risk of complications
Cesarean Delivery is the MC operative procedure in the US, rates are climbing due to repeat c-section, continuous electronic fetal monitoring, macrosomia, dec use of operative vaginal methods, reproductive technology or due to fear of?
Litigation
Indications for Cesarean Delivery fetal: bad FHR, breech/ transverse presentation, very low birth weight, active HSV, immune thrombocytopenia purpura, congenital anomalies, Maternal-fetal: cephalopelvic disproportion, failiure to progress, placental aburption or?
Placenta previa (duh covering th cervix = BLOOD)
Indications for Cesarean Delivery for maternal include obstructive benign/malignant tumors, large vulvar condylomas abd cervical cerclage (past cervical surgeries), prior vaginal colporrhaphy, maternal request…. and?
conjoined twins
