Assisted vaginal birth Flashcards

1
Q

What position is good for passive decent with an epidural

A

lateral position. Lower risk of needing instrumental

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2
Q

Which positions have a reduced rate of instrumental delivery

A

upright and lateral

although slight increased risk of 2nd degree tears

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3
Q

Situations in which forceps will be chosed over vacuum

A
  1. Malpresentation - face or breech extraction
  2. Dense epidural may impeded ability to push which is necessary for vacuum
  3. If birth needs to be quicker
  4. Less than 34 weeks
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4
Q

Complciations for assisted delivery for mums

A

Tears
Need for episiotomy
Birth trauma (mentally)
PPH
Pelvic floor damage
Urinary retention
Dyspareunia

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5
Q

Reasons why vacuum > forceps

A

Lower rates of epis/tears
Lower pain after delivery

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6
Q

Neonatal complications assisted deliveries

A

Facial trauma
Higher need for resus
Cephalohaematoma
Subgaleal haematoma
Subdural/subarachnoid haemorrhage
neurological injury
skull fracture
shoulder dystocia
jaundice

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7
Q

What are the two injuries on baby’s head that vacuum cups are at higher risk of and which one do we care about?

A

Cephalhaematomas - limited space. Deeper. Do not cross suture line.
Subgaleal haematomas - more superficial - BAD - mortality 20%. Large potential space and can result in shock

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8
Q

Why do assisted deliveries have a higher rate of early cessation of breastfeeding?

A

facial nerve injury
maternal or fetal pain
jaundice causing sedation

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9
Q

Materal indications for instrumental delivery

A

Maternal exhaustion - do not push until really feel the urge. Prolonged 1/2nd stage results in tiredness

Insufficient uterine activity - consider use of synto

Epidurals - impaired sensation. Definitely do passive decent if able

Maternal illness - extensive valsalva might be contrindicated for maternals disease e.g. cardiac

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10
Q

Materno-fetal indications for instrumental delivery

A

Malposition - OP babies can be manually rotated. OR rotated using forceps OR delivered with forceps/vacuum as OP

Malpresentation - mentum anterior can be delivered with facial forceps. NOT VACUUM

Macrosomia - might need instrumental but size needs to be assessed with examination prior to trying this

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11
Q

Fetal indications for instrumental delivery

A

Dodgy CTG in 2nd stage

2nd stage:
- nullips - after 2h 2nd stage or 3h with epidural
- multips - after 1h 2nd stage or 2h epidural

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12
Q

What are the conditions that need to be satisfied before instrumental birth attempted

A
  1. Maternal consent
  2. Baby in appropriate position
  3. Baby low enough
  4. Full dilatation
  5. Adequate pain relief
  6. Operative theatre if a trial
  7. Membranes ruptured
  8. No known disproportion of head and pelvis
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13
Q

What is an outlet procedure/low pelvic procedure/mid pelvic procedure/high pelvic procedure

A

Outlet - head at perineum, can be seen in contractions
Low - lower than +2
Mid - higher than +2
High - not engaged (these are not done anymore)

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14
Q

What is classified as a rotational procedure

A

more than 45 degree rotation

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15
Q

What is the acronym for vacuum cup delivery

A

Address woman - explain everything
Ask for help
Abdo palpation
Analgesia

Bladder - make sure empty with in-out catheter

Cervix - make sure fully dilated

Determine position

Equipment - make sure have birth tray and resus availability

Flexion point - 3cm anterior to posterior fontanelle

Gentle traction - constant gentle traction

Halt the procedure after 3 pop offs or if no decent after 3 pulls
Halt if been more than 20 minutes or consider after 10 to stop

Incision - episiotomy when crowning

Jaw - when jaw reachable remove vacuum and deliver

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16
Q

What analgesia for forceps

A

If no epidural may need pudendal block

17
Q

Acronym for how to do FORCEPS

A

Address woman
Analgesia - epidural or pudendal block
Abdo palp
Ask for help

Bladder - empty

Cervix - dilated

Determine position

Equipment for birth/resus

Forceps applied - COVER IN JELLY
Try them outside the body first
Left always first
Shank anterior when putting it in then right hand to protect the maternal tissues
Rigth over left
Should link together easily

Gentle traction - pagot’s manouver. HAnd on top of shanks pushing downwards and one hand on shanks pulling outward in horizontal direction - creates a out and down direction and then once occiput is under the symphsis then can arc upwards

Handles now elevated so the shanks are upwards.

Incision - when head crowning can do epis. Neville barnes allow epis cutting through the split

Jaws - remove forceps (right blade first - up and anteriorly) and deliver baby after you can feel the jaw

18
Q

How do you check that the forceps are applied correctly?

A

Position for Safety

Posterior fontanelle - should be central and 1cm above the plane of the shanks

Fenestration - should onyl emit a finger and not more than this. Make sure they are far enough in

Lambdoind Sutures should be equidistant to the upper surfaces of the blades - makes sure the sagittal suture is midline

19
Q

What to do after an assisted birth has been done

A

Think about PPH

Look at perineum

Evaluate baby for injury (vit K as soon as possible for babies at risk of subgaleal haematomas)

Think about bladder care

20
Q

How to document after assisted delivery

A

Indication

Examination findings

Consent

Procedure (can do A-J)

Management of third stage

Instructions for care

21
Q

Indications for a trial of assisted delivery

A

BMI >30

Still 1/5 palpable abdominally

Baby weight >4kg or clinical suspiscion that it is large

OP position