[CLMD] Operative Delivery [Wootton] Flashcards
What are the 2 categories of Operative Delivery?
Vaginal (Foreceps, Vacuum)
Cesarean Delivery
When would we need to use Operative Vaginal Delivery (Maternal Indications?)
Maternal Exhaustion
Spinal Cord Injury, Neuromuscular Disorders
Cardiac Conditions
Cerebrovascular Dz
What fetal indications would tell us to use a Operative Vaginal Delivery?
Non-Reassuring Fetal Status
What are some Maternal Criteria necessary to begin an Operative Vaginal Delivery?
Analgesics
Lithotomy position
Bladder Empty
Verbal or written consent to abandon and go to C-Section
What are some Fetal Criteria necessary for OVD?
Vertex position
Fetal head must be engaged
Position of fetal head MUST BE KNOWN
Fetal weight estimated
station must be >+2
Can you do a OVD if the cerivx isnt fully dilated, membranes arent ruptured, and the person has a placenta previa?
NO!
What are the Different Classifications of OVD?
Outlet
Low
Midpelvis and High Forceps
You have a scalp visible at the introitus without separating the labia, and the fetal skull has reached the pelvic floor. The Rotation does not exceed 45 degrees, and the Sagittal suture is in the AP diameter or R/L OA/OP position – What classification of OVD is warranted?
Outlet
The leading point of the fetal head is at a +2 station or more, and is not on the pelvic floor – what classification of OVD is warranted?
Low
Fetal skull is above the +2 station – what not ever indicated classification of OVD is being done?
Midpelvis and High Forceps
What position of the Fetal head cant come out of any pelvis?
Right Occipito Transverse
Left Occipito Transverse
What are some Maternal postop complications of a forceps delivery?
Lacteration of Cervix/Vagina
Episiotomy extension
Pelvic Hematomas
Urethral/Bladder injuries
Uterine Rupture
What are some Fetal postop complications of forceps delivery?
Minor Facial Lacerations (Forceps marks)
Brachial Plexus injuries
skull fractures
Intracranial Hemorrhage
Seizures
Are the indications and requirements for Vacuum assisted vaginal delivery any different than Forceps?
NO!
(The advantage to vacuum is that you need little maternal analgesia)
When would you never do a Vacuum assisted Vaginal Delivery?
<34 weeks
Fetal Coag Disorder
Fetal Macrosomia
Breech presentation
What is the correct placement of the vacuum cup on the fetuses head?
On the Posterior Fontanelle
When do you release suction during labor?
what are some clinical pearls?
Between contractions
(No more than 2 pop-offs)
(Don’t apply for more than 20 mins)
(No Twisting)
Which of the two Vaginal deliveries has more complications?
Vacuum
(more failed deliveries)
(increased fetal cephalohematoma, ICH)
(more scalp lacerations)
Would you ever do both a Vacuum and Forceps vaginal delivery (one after the other)?
No!
Increased risk of fetal death
What are some Fetal indications for C-Section?
Non Reassuring Fetal HR
Breech Presentation/Transverese
VL Birth Weight
Active HSV infection
Immune Thrombocytopenia Purpura
Congenital Anomalies
What are some Maternal indications for C-Section?
Obstructive Benign, Malignant tumors
Large Vulvar Condlyoma
Abdominal Cervical Cerclage
Prior Vaginal Colporrhaphy
Conjoined Twins
What is the most common incision for C-Section, that also allows the mother to (in the next pregnancy) still have a Vaginal Delivery?
Pfannenstiel
What are some Postoperative Complications of C-Section?
Endomyometritis (infxn of uterus)
Wound Infxn, Separation, Dehiscence
Urinary Complications
GI complications
Thromboembolic Disorder
Septic Pelvic Thrombophelbitis
