2P - Operative Obstetrics

Question 1

What local anesthesia is used during midline episiotomy?

Answer 1

2% lidocane 5-10 cc

Question 2

What is of utmost importance during the midline episiotomy?

Answer 2

Protecting the fetal head

index and middle fingers are inserted into between head and perineum

Question 3

In midline episiotomy, a vertical midline incision is made where and to?

Answer 3

Posterior fourchette to the anus

Question 4

2 important functions of repair in episiotomy?

Answer 4

hemostasis and tissue reaapproximation

Question 5

From the apex of the vaginal laceration, how many cm should the suture start?

Answer 5

1 cm

Question 6

How do we stitch the bulbocavernous muscle?

Answer 6

interrupted crown stitch

Question 7

How do we stitch the transverse perineal muscles?

Answer 7

interrupted or running sutures

Question 8

What is the final step in medial episiotomy after the reapproximation of the perineal body?

Answer 8

knot of the hymenal ring

Question 9

how many degrees should the mediolateral episiotomy incision be positioned from the perineal body?

Answer 9

45 degrees

Question 10

What is the extent of 2nd degree tear?

Answer 10

Muscular layer

Question 11

What is the extent of 3rd degree tear?

Answer 11

anal sphincter

Question 12

What is the extent of 4th degree tear?

Answer 12

rectum below the anal sphincter

Question 13

What is the extent of 1st degree tear?

Answer 13

only the skin

Question 14

One of the most common complications of episiotomy?

Answer 14

Bleeding

Question 15

Which has more bleeding time, medial or mediolateral episiotomy?

Answer 15

Mediolateral

Question 16

What incision has the higher chance for 3rd and 4th degree lacerations?

Answer 16

Midline

Question 17

A life threatening infection which can appear weeks post episiotomy?

Answer 17

necrotizing fasciitis

Question 18

First Generation cephalosporins used for infections during episiotomy?

Answer 18

Cephalexin and Cefazolin

Question 19

Antibiotics used if patient is allergic to macrolides?

Answer 19

Beta lactams and beta lactamase inhibitor (ampicillin and sulbacatam - IV alternative) (Amox + clavulanate - oral)

Question 20

Part of the forceps that grabs the fetus?

Answer 20

Blade

Question 21

Connects the blade and the handle?

Answer 21

Shanks

Question 22

What is the position required to be able to use outlet forceps and where should the fetal skull already be?

Answer 22

AP position with the fetal skull and the pelvic floor

Question 23

What should be the fetal station to start the low forceps?

Answer 23

+2

Question 24

IF the fetal station is above +2, what forceps delivery is recommeded?

Answer 24

Mid forceps

Question 25

What is the angulation that indicates use of forceps?

Answer 25

less than 45 degrees

Question 26

If no contraindications exist, what are the criteria for prolonged second stage of labor indicates use of forceps delivery?

Answer 26

Nullipara
2 hours without and 3 hours with anesthesia

Multipara
1 hour with and 2 hours with anesthesia

Question 27

What forceps can be used during breech delivery if there is difficulty in delivering the fetal head?

Answer 27

Piper’s Forceps

Question 28

Where should be the newborn be examined if vacuum extraction for delivery was done?

Answer 28

Top of the head

Side if forceps delivery

Question 29

When should postpartum examination be done?

Answer 29

after 4-6 weeeks

Question 30

Patients post assisted forceps or vacuum delivery should be monitored for how long before discharge?

Answer 30

2 hours

Question 31

Pelvic rest post assisted delivery should last how long?

Answer 31

2 weeks

Question 32

Most common side effect of delviery?

Answer 32

cramping