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Gaby’s Green Top Guidelines > 2020 Assisted Vaginal Birth > Flashcards

2020 Assisted Vaginal Birth Flashcards

1
Q

How can assisted vaginal birth be avoided?

A
  1. Continuous support in labour
  2. Maybe avoid epidural
  3. Latent vs active phase PCEA not worse
  4. Upright or lateral position if no PCEA
  5. Lying down lateral if PCEA
  6. Delay pushing by 1-2 hours if nullip with PCEA
  7. Do not discontinue PCEA during pushing
  8. Not enough evidence for particular regional analgesia technique, oxytocin or prophylactic manual rotation
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2
Q

When is operative vaginal birth contraindicated?

A
  1. No absolute contraindications
    Relative:
  2. Suspected fetal bleeding disorders
  3. Predisposition to fracture
  4. BBV in mother
  5. Vacuum <32/40, caution 32-36
    NOT:
  6. Following FBS or FSE
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3
Q

How do you classify an outlet assisted vaginal birth?

A
  1. Fetal scalp visible without parting labia
  2. Fetal skull has reached perineum
  3. Rotation does not exceed 45•
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4
Q

How do you classify a low or mid cavity assisted vaginal birth?

A

Low: skull at +2 but not on perineum
Mid: fetal head <= 1/5 palpable PA
Leading point of skull at 0 or +1
Non-rotational <=45•
Rotational > 45•

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5
Q

What are the fetal indications for assisted vaginal birth?

A

Suspected fetal compromise,
1. Pathological CTG
2. Abnormal FBS
3. Thick meconium

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6
Q

How is lack of progress in 2nd stage defined?

A
  1. 3 hours nullip with PCEA
  2. 2 hours nullip with no PCEA
  3. 2 hours parous with PCEA
  4. 1 hour parous with no PCEA
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7
Q

What are the maternal indications for assisted vaginal birth?

A
  1. Lack of progress in 2nd stage
  2. Maternal exhaustion or distress
  3. Medical indications to avoid Valsalva
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8
Q

What are the examination safety criteria for assisted vaginal birth?

A
  1. Head <= 1/5 palpable PA
  2. Cx fully dilated
  3. Membranes ruptured
  4. Station at or below spines
  5. Position of fetal head determined
  6. Caput & moulding moderate or less
  7. Pelvis deemed adequate
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9
Q

What are the maternal preparations necessary for assisted vaginal birth?

A
  1. Clear explanation & informed consent
  2. Trust & full co-operation
  3. Analgesia: ideally regional if mid or rotational, pudendal if urgent, could have perineal for low or outlet
  4. Maternal bladder emptied
  5. Indwelling catheter removed or deflated
  6. Aseptic technique
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10
Q

What are the staff preparations necessary for assisted vaginal birth?

A
  1. Skilled operator
  2. Adequate equipment, bed, lighting
  3. Access to operating theatre
  4. Anticipation of SD, PPH, perineal trauma
  5. Neonatal team present
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11
Q

What are the staff preparations necessary for assisted vaginal birth?

A
  1. Skilled operator
  2. Adequate equipment, bed, lighting
  3. Access to operating theatre
  4. Anticipation of SD, PPH, perineal trauma
  5. Neonatal team present
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12
Q

How does vacuum compare to forceps?

A
  1. More likely to fail
  2. More cephalohaematoma
  3. More retinal haemorrhage
  4. More maternal worries about baby
  5. Less perineal & vaginal trauma
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13
Q

When should assisted vaginal birth be discontinued?

A

More than 3 pulls to perineum
2 pop-offs of vacuum

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14
Q

What aftercare is required following assisted vaginal birth?

A
  1. Antibiotics: single dose IV Co-Amos
  2. VTE reassessment
  3. Regular paracetamol & NSAIDs
  4. Bladder care
  5. Debrief
  6. Paired cord blood samples
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15
Q

What serious rare complications of assisted vaginal birth can result in perinatal death?

A
  1. Subgaleal haemorrhage
  2. Intracranial haemorrhage
  3. Skull fracture
  4. Spinal cord injury
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16
Q

In what circumstances are the risks of failure or complications increased in assisted vaginal birth?

A
  1. Raised maternal BMI >30
  2. US EFW >4kg
  3. OP position
  4. Mid-cavity delivery or head 1/5 PA
    Therefore should be trial in theatre
17
Q

How should information on risk be described?

A

Very common: 1/1 to 1/10
Common: 1/10 to 1/100
Uncommon: 1/100 to 1/1000
Rare: 1/1000 to 1/10,000
Very rare: <1:10,000

18
Q

Maternal serious risk stats for assisted vaginal birth

A
  1. OASI with vacuum common, 1-4%
    OASI with forceps v common, 8-12%
  2. Extensive tear v common, vacuum 10%, forceps 20%
19
Q

Fetal serious risk stats for assisted vaginal birth

A
  1. Subgaleal haematoma uncommon, 3-6:1000
  2. Intracranial haemorrhage uncommon, 5-15:10,000
  3. Facial nerve palsy rare
20
Q

Maternal frequent risk stats for operative vaginal birth

A
  1. PPH v common, 10-40%
  2. Vaginal tear or abrasion v common
  3. Anal sphincter dysfunction or voiding dysfunction (no stats!)
21
Q

Fetal frequent risk stats for assisted vaginal birth

A
  1. Forceps marks on face v common
  2. Ventouse chignon v common
  3. Cephalhaematoma 1-12%
  4. Facial or scalp lacerations 10%
  5. Jaundice/hyperbiliribinaemia 5-15%
  6. Retinal haemorrhage 17-38%
22
Q

Fetal frequent risk stats for assisted vaginal birth

A
  1. Forceps marks on face v common
  2. Ventouse chignon v common
  3. Cephalhaematoma 1-12%
  4. Facial or scalp lacerations 10%
  5. Jaundice/hyperbiliribinaemia 5-15%
  6. Retinal haemorrhage 17-38%
23
Q

What additional procedures should be consented for with assisted vaginal birth?

A
  1. Episiotomy, 50-60% vacuum, 90% forceps
  2. SD manoeuvres
  3. Caesarean
  4. Blood transfusion
  5. Repair of perineal tear
  6. Manual rotation if needed
24
Q

What are the risks of 2nd stage Carsarean?

A
  1. Major obstetric haemorrhage
  2. Prolonged hospital stay
  3. NNU admission

Gaby’s Green Top Guidelines (27 decks)

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