52. Obstetric operations. Cesarean section (indications) Flashcards
when can forceps delivery be done?
during the 2nd stage of labor
in the case of any condition threatening the mother or fetus, that is likely to be relieved by delivery.
what does forceps delivery for?
Facilitates delivery by applying traction to the fetal skull. The cephalic curve of the forceps conforms to the shape of the fetal head; the pelvic curve corresponds to the axis of the birth canal
Prerequisites for forceps application
- Trained obstetrician in forceps procedures
- Fully dilated cervix
- Ruptured membranes
- Fetal head is engaged (the greatest transverse diameter in an occiput presentation passes through the pelvic inlet)
- Suitable size and shape of fetal head
- Living fetus
- No concern for cephalopelvic disproportion
Prophylactic indications for forceps delivery/ vacum extraction
- Prolonged 2nd stage of labor
- Threatened intrauterine fetal asphyxia
- Maternal disease
- Previous uterine operation
vital indications for forceps delivery/vaccum extraction
- Heart failure, pulmonary edema
- Eclampsia
- Severe hemorrhage, DIC
- Definite fetal hypoxia
potential complications of forceps delivery
-Maternal injury → vaginal/bladder/perineal/rectal injuries.
-Fetal cephalohematoma, intracranial bleeding, skull traction.
-Fetal Bell’s palsy (CN VIII).
types of forceps
- outlet: the scalp is visible at the introitus without separating the labia
- low: the leading part of the fetal skull is at station +2 cm or more.
- mid: the fetal head is engaged, but the leading point of the skull is above station +2 cm
what is The vacuum extractor (VE) ?
instrument that uses a suction cup that is applied to the fetal head
when is vacuum extraction contraindicated?
the fetus presents by face or breech presentation, and in preterm deliveries.
what is the most important determinant of the success of vacuum extraction?
proper cup replacement
the cup should be placed over the sagittal suture, 3 cm in front of the posterior fontanelle (anterior placement may result in cervical spine extension, asymmetrical placement may worsen asynclitism
prophylactic maternal indications for C-section
- Maternal illness
- Previous operation on the uterus (myomectomy, C-section)
- Contracted pelvis (diminished pelvic capacity)
- Late primiparity
prophylactic fetal indications for C-section
- Threatened fetal asphyxia (scalp pH 7.21-7.25)
- Placental dysfunction
- Fetal illness
- Pregnancy after fertility treatment
prophylactic maternal- fetal indications for C-section
- Based on gestational history
- Dystocia, prolonged labor
- Cephalopelvic disproportion, malpresentation, malposition
- Twin pregnancies (not in all cases)
vital maternal- fetal indications for C-section
- Eclampsia
- Uterine rupture
- Placenta previa
- Placental abruption
vital maternal indications for C-section
- Heart failure, pulmonary edema
- Severe hemorrhage, DIC
vital fetal indications for C-section
- Fetal asphyxia (scalp pH < 7.21)
- Umbilical cord prolapse
- Neglected transverse lie
- Ascending infection, fetal pneumonia
Potential candidates of vaginal delivery after c-section
- one cesarean delivery in the past
- clinically adequate pelvis
- no other uterine scars or previous rupture
- physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean if needed.
types of abdominal incision
- Vertical incision – lower median
- Low transverse incision (Pfannenstiel)
types of uterine incision
- Classical (corporal longitudinal)
- Low vertical
- Low cervical-transverse
which uterine incision is associated with low risk of future uterine rupture?
low transverse incision
complication of C-section
- Bladder injury (0.3%)
- Ureter injury (< 0.1%)
- Bowel injury (0.2%)
- Postpartum hemorrhage
- Infection
- Pulmonary embolism post-operative
what is cervical cerclage?
a circumferential suture placed into the cervix
the surgical treatment of cervical insufficiency (cervical incompetence).
when is a cervical cerclage placed?
at 13-16 weeks gestation based on clinical diagnosis (history of cervical insufficiency),
or at 20-24 weeks gestation based on transvaginal US findings
the suture is typically removed before the onset of labor (transvaginal cerclage)
definition of cervical insufficiency (cervical incompetence).
the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor (recurrent painless cervical dilation leading to 2nd-trimester pregnancy losses).
types of cervical cerclage
- McDonald-type cervical cerclage
- Shirodkar-type cervical cerclage
- Transabdominal cervical cerclage
