2P - Operative Obstetrics Flashcards
What local anesthesia is used during midline episiotomy?
2% lidocane 5-10 cc
What is of utmost importance during the midline episiotomy?
Protecting the fetal head
index and middle fingers are inserted into between head and perineum
In midline episiotomy, a vertical midline incision is made where and to?
Posterior fourchette to the anus
2 important functions of repair in episiotomy?
hemostasis and tissue reaapproximation
From the apex of the vaginal laceration, how many cm should the suture start?
1 cm
How do we stitch the bulbocavernous muscle?
interrupted crown stitch
How do we stitch the transverse perineal muscles?
interrupted or running sutures
What is the final step in medial episiotomy after the reapproximation of the perineal body?
knot of the hymenal ring
how many degrees should the mediolateral episiotomy incision be positioned from the perineal body?
45 degrees
What is the extent of 2nd degree tear?
Muscular layer
What is the extent of 3rd degree tear?
anal sphincter
What is the extent of 4th degree tear?
rectum below the anal sphincter
What is the extent of 1st degree tear?
only the skin
One of the most common complications of episiotomy?
Bleeding
Which has more bleeding time, medial or mediolateral episiotomy?
Mediolateral
What incision has the higher chance for 3rd and 4th degree lacerations?
Midline
A life threatening infection which can appear weeks post episiotomy?
necrotizing fasciitis
First Generation cephalosporins used for infections during episiotomy?
Cephalexin and Cefazolin
Antibiotics used if patient is allergic to macrolides?
Beta lactams and beta lactamase inhibitor (ampicillin and sulbacatam - IV alternative) (Amox + clavulanate - oral)
Part of the forceps that grabs the fetus?
Blade
Connects the blade and the handle?
Shanks
What is the position required to be able to use outlet forceps and where should the fetal skull already be?
AP position with the fetal skull and the pelvic floor
What should be the fetal station to start the low forceps?
+2
IF the fetal station is above +2, what forceps delivery is recommeded?
Mid forceps
What is the angulation that indicates use of forceps?
less than 45 degrees
If no contraindications exist, what are the criteria for prolonged second stage of labor indicates use of forceps delivery?
Nullipara
2 hours without and 3 hours with anesthesia
Multipara
1 hour with and 2 hours with anesthesia
What forceps can be used during breech delivery if there is difficulty in delivering the fetal head?
Piper’s Forceps
Where should be the newborn be examined if vacuum extraction for delivery was done?
Top of the head
Side if forceps delivery
When should postpartum examination be done?
after 4-6 weeeks
Patients post assisted forceps or vacuum delivery should be monitored for how long before discharge?
2 hours
Pelvic rest post assisted delivery should last how long?
2 weeks
Most common side effect of delviery?
cramping
