Caesarean section and assisted vaginal delivery Flashcards
What percentage of births are assisted (forceps/vacuum)?
Approximately 10%
What are the necessary factors required for assisted birth?
Head must be engaged, membranes
ruptured, position of head known, station below the spines
presentation suitable, moulding not
excessive, cervix fully dilated, uterus
contracting, adequate analgesia, empty
bladder, neonatal resuscitator in
attendance
What are the indications for forceps
delivery?
Delay in the second stage/maternal
exhaustion, dense epidural block with
diminished urge to push, malposition of
fetal head, fetal distress, prolapsed
cord, eclampsia.
Also used to prevent undue maternal
effort in cases of comorbidities such as
cardiac, respiratory disease etc.
What is the incidence of caesarean
sections in Australia?
Approximately 30% (public), 40%+ (private)
Where is the cup of the Ventouse
(vaccuum extractor) attached and why?
Over the posterior fontanelle to facilitate fetal head flexion.
Appropriate rotation during delivery occurs with traction.
What are the recognised potential complications of forceps use?
Maternal: increased risk of perineal trauma, e.g. 3rd degree tear
Fetal: facial bruising, VII paralysis, skull fracture
What are the contraindications for vacuum delivery?
If head is above ischial spines, face presentation, breech presentation, prematurity <34 weeks
What are the maternal indications for caesarean section?
Prior classical C-section (vertical incision predisposes to uterine rupture), active genital herpes infection, cervical carcinoma, maternal trauma/demise, HIV, infection
What are the fetal indications for caesarean section?
malpresentation (transverse lie, shoulder presentation), fetal distress, cord compression/prolapse
What are the materno-fetal indications for caesarean section?
Cephalopelvic disporportion, placenta
praevia/abruption, failed induction of labour
What are the two types of Caesarean skin
incisions, and the benefits and
drawbacks of each?
- Transverse (Pfannensteil)
Benefits
• Improved strength
• Preferable cosmetic outcome
Limitations
• Slower entry
• Decreased peritoneal exposure - Vertical midline
Benefits
• Rapid peritoneal entry
• Less bleeding and nerve injury
• Increased abdominal exposure
Limitations
• Increased risk of wound
dehiscence
What are the three types of Caesarean
uterine incisions, and the indications and
implications for each?
- Low transverse
• Most common
• Placement in non-contractile segment means there is a
decreased chance of rupture in subsequent pregnancies. - Low vertical
• Used for very preterm infants
• Useful for poorly developed maternal lower uterine segment. - Classical (vertical cut in thick,
contractile segment)
• less commonly used
• Greater risk of uterine rupture in
subsequent pregnancies
• Useful for:
Transverse fetal lie
Lower segment fibroids
Severe prematurity where CS done for other indications
Caesarean hysterectomy e.g. praevia accreta
What are the advantages of Vacuum Extraction compared to Forceps delivery?
Vacuum:
• Is easier to apply (less skill required)
• Requires less anaesthesia
• Less maternal soft-tissue injury
As compared to forceps.
What are the advantages of a Forceps delivery over a Vacuum Extraction?
Forceps:
Have a higher overall success rate for vaginal delivery
Can be used at earlier gestations
When compared to a vacuum extraction.
What are some of the major risks and
short term complications of Caesarean
sections?
• Haemorrhage
• Infection (wound, endometrial &
UTI)
• Injury to surrounding structures
(bladder, bowel, ureters, cervix
and other sections of the uterus)
• Thromboembolism
• Anaesthetic risks
• Increased recovery time
• Maternal death (exceedingly rare)
