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Obstetrics and Gynecology > Delivery > Flashcards

Delivery Flashcards

1
Q 
Easy surgical repair
Rare faulty healing
Minimal postoperative pain
Excellent anatomical result
Less blood loss
Rare dyspareunia
Common extensions
A

Midline episiotomy

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2
Q 
More difficult surgical repair
More common faulty healing
Common postoperative pain
Occasionally faulty anatomical results
More blood loss
Occasional dyspareunia
Uncommon extensions
A

Mediolateral episiotomy

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3
Q

Lowest risk of maternal and fetal comorbidity

Inc risk for pelvic floor disorder

A

SVD

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4
Q

50 minutes in nullipara
20 minutes in mutlipara

Healthy neonate with minimal trauma to the mother is the culmination

A

Second stage of labor

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5
Q

Done when HEAD distends vulva and expulsive efforts are inadequate

Forward pressure on fetal chin in front of maternal coccyx by one hand

Other hand exerts pressure superiorly against the occipit

Promotes controlled delivery of the head
Promotes neck extension so that the smallest diameter of the head passes through the introitus

A

Modified Ritgen Maneuver

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6
Q

Attendant does not touch perineum during delivery of the head

Compared with traditional perineal support, does not appear to offer greater third degree laceration protection

A

Hands-poised method

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7
Q

Done after fetus had undergone restitution and external rotation to transverse position and shoulders appear at the vulva

Hooking fingers in the axillae is avoided

A

Shoulder delivery

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8
Q

Anterior fetal shoulder becomes wedged behind symphysis pubis and fail to deliver using normally exerted downward traction and maternal pushing

A

Shoulder dystocia

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9
Q

Removing legs from stirrup and flexing the thighs up unto the abdomen also providinf suprapubic pressure

A

McRoberts maneuver

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10
Q

Hand is placed behind posterior shoulder and shoulder rotated 180 degrees until anterior shoulder is released

A

Woods corckscrew maneuver

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11
Q

Cephalic replacement into the pelvis followed by CS

Terbutaline 0.25 mg is given SQ to induce uterine relaxation

A

Zavanelli maneuver

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12
Q

Shoulder-to-shoulder diameter is aligned vertically then accessible shoulder is pushed toward anterior chest of wall of the fetus

A

Rubin maneuver

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13
Q

Third stage of labor

A

Placental delivery

Uterotonic administration

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14
Q

Signs of placental separation

A

Globular and firmer uterus
Sudden gush of blood into the vagina
Uterus rises in abdomen
The umbilical cord protruding further out the vagina

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15
Q

Downward pressure above symphysis pubis while pushing uterus cephalad when with delayed placental separation

A

Kristeller’s maneuver

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16
Q

First 1 hr after delivery
Repair of lacerations
WOF postpartum hemorrhage

A

Fourth stage of labor

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17
Q

Superficial tear involving skin and mucous membrane, fourchette and periurethral skin

A

First degree

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18
Q

Tears extend into fascia and muscles
Bulbocavernosus and superficial transverse perineal

Forms irregular triangle due to extension upward and one or both sides

A

Second degree

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19
Q

Extends into or through external anal sphincter

A

Third degree

20
Q

Extension into anorectal muscle with disruption of both external and internal anal sphincter

A

Fourth degree

21
Q

More hemorrhage
Cuts through blood vessels

Less severe extension to anorectal area as sole advantage

A

Mediolateral ep

22
Q

Two most important discriminators of risk for both mother and infant using forceps delivery

A

station
rotation

Outlet - scap visible
Low - + 2 head station
Mid - 0 + 2 head station
High - no place in modern OB

23
Q

A persistent occiput posterior
Transverse position of fetus

use

A

Forceps

24
Q

Indications for forceps delivery

A 
Maternal heart disease
Pulmo compromise
Intrapartum infection 
Neurologic conditions
Maternal exhaustion
Non-reassuring fetal heart rate pattern
Premature placental separation and prolonged second stage of labor (most common) prolonged by regional anesthesia
25
Q

Forceps with fenestrated blades
Best used for delivery of molded head
Curved blade fits the pelvis

Common in nulliparous

A

Simpson of Elliot forceps

26
Q

Also used for molded head but ideal for head rotation because of no pelvic curvature

No fenestration in central opening

A

Kielland forcep

27
Q

Best used for rounded head because of its thin, smooth blades

A

Tucker-Mclane forceps

28
Q

Maternal morbidity from forceps delivery

A

Postpartum urinary retention
Bladder dysfunction
Urinary fecal and flatus incontinence

29
Q

Fetal morbidity following forceps delivery

A

Facial nerve palsy
Skull fracture
Intracranial hemorrhage

30
Q

Same indications as forceps but cannot be used for face presentation or fetal coagulopathy (use forceps)

Rigid or soft cup places 3cm in front of posterior fontannel centering sagittal sutures

Vacuum generated from machine slowly up to 600mmHg creating chignon or artificial caput on feral head

A

Vacuum extraction

Abandon when no descent of head despite adequate traction or if cup dislodges 3x

31
Q

Vacuum extraction complications mostly fetal

A 
Scalp laceration
Bruising
Subgaleal hematoma
Cephalhematoma
ICH
32
Q

Most common breech presentation in delivery

A

Frank breech (buttocks)

33
Q

Breech predisposing factors

A 
Oligohydramnios/Polyhydramnios
High parity
Multiple fetus
Preterm fetus - most common
Fetal malformation - 17% preterm and 9% term
Uterine anomalies or fibroids 
Placenta previa
Fundal placement implantation
Pelvic tumors
High parity with uterine relaxation
Prior breech delivery
34
Q

Lower extremities are flexed at hips
Knees extended

Pike position feet lie beside the head

50-70%

A

Frank breech

35
Q

One or both knees flexed
Flexed at hips against the abdomen with one or both knees flexed

Buddah position
Cannonball position

5-10%

A

Complete breech

36
Q

One or both hips extended and one or both feet or knees lies below the breech such that foot or knee is lowermost in the birth cana

Footling

10-30%

A

Incomplete breech

Single footling - one leg extended and the other flexed

Double - both legs extended below level of buttocks, possible risk of umbilical cord accident

37
Q

Breech may be delivered vaginally

A

Frank

Complete

38
Q

More common in breech presentation

A

Umbilical cord prolapse

39
Q

CS indications

A 
Large fetus >4000 g
Any degree of pelvic contraction (platypelloid, android)
Hyperextended head (stargazer fetus)
Uncontrolled pre-eclampsia 
Uterine dysfunction
Incomplete or footling breech
PPROM 
Severe FGR
Previois perinatal death from birth trauma
40
Q

Spontaneous delivery up to umbilicus and rest of the fetal body is delivered with assisted maneuvers and traction

Most commonly employed
Avoids prolonged cord compression

A

Partial breech extraction

41
Q

Done in footling breech

A

Total breech delivery

42
Q

Delivery of the aftercoming head with fetal head being delivered, flexion of the head is maintained by suprapubic pressure provided by an assistant

Pressure on maxilla is applied simultaneously by the operator as upward and outward traction

Breech

A

Mauriceau Maneuver

43
Q

Used for persistent backdown fetuses

2 fingers grasping the fetal shoulders from below while the feet are drawn upward up towards the maternal abdomen

A

Modified Prague Maneuver

44
Q

Use of forceps when Mauriceau and Prage fails

A

Piper of Laufe forceps

45
Q

Decomposes breech

A

Pinard’s maneuver

46
Q

Performed when there is entrapment of aftercoming head and gentle traction on the fetal body does not help occiput slip out

2 oclock
10 oclock
6 oclock incisions

A

Duhrssen incision

Obstetrics and Gynecology (18 decks)

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