Emergency C Section Flashcards
When is operative delivery more common?
Primiparous women
Supine and lithotomy positions
Epidural anaesthesia
What is the fetal station?
Relationship of presenting part (head, buttocks, feet) to the ischia spines (assessed vaginally). Measured in cm above or below the ischial spines
What is caput succedaneum?
Diffuse swelling of the scalp caused by pressure of the scalp against the dilating cervix during labour. Associated with moulding
Graded subjectively from 0 (none) to +3 (marked)
What is moulding?
The bones of the fetal head move closer together or overlap to help the head fit through the pelvis. Parietal bones overlap occipital and frontal bones
Up to +2 occipito-parietal moulding may be normal in later stages of labour.
+2 parietal bones overlap but easily reduced
+3 irreducible. Never normal. Sign of relative or absolute cpd
Why is it advised that primiparous women who have epidurals should have 2 hours of passive second stage?
Meta-analysis have shown more likely to have fewer rotational or mid-cavity operative interventions when pushing is delayed for 1-2 hours or until they had a strong urge to push
How do you assess CTG?
DR C BRAVADO
Define Risk Contractions - 3:10 = 3 every 10 minutes Baseline RAte - 110-160bpm Variability - 5-25 Accelerations - generally a sign the baby is healthy Decelerations* Overall
Classification for operative vaginal delivery
Outlet - scalp visible/ skull reached pelvic floor
Low - skull at station +2 or more and not on pelvic floor
Mid - skull above station +2 but ≥0 no more than 1/5 palpable per abdomen
High - not suitable for operative vaginal delivery. >2/5th palpable, presenting part above ischial spines
Indications for operative vaginal delivery
Fetal compromise
Shorten stage II due to maternal medical conditions
Inadequate progress
- nulliparous lack of progress for 3 hours with, 2 hours without anaethesia
- mulitiparous 2 hours with, 1 without
-maternal fatigue/exhaustion
Types of forceps
Simpsons/Neville Barnes (non-rotational)
Kiellands forceps rotional
Vacuum extraction compared with forceps delivery
More likely to fail
More like to be associated with cephalhaematoma or retinal haemorrhage
Less likely associated with perineal and vaginal trauma making (making vacuum delivery as instrument of first choice)
No more likely associated with c section
No more likely associated with low 5 minute APGAR score
When should operative vaginal delivery be abandoned?
When no evidence of progressive descent with moderate contraction and delivery is not imminent following three contractions
Operative vaginal delivery - higher rates of failure:
BMI 30
EFW over 4kgvor clinically big baby
OP position
Mid-cavity delivery or when 1/5th of head palpable per abdomen
Complications of c-section in stage II of labour?
Maternal: uterine/cervical/high vaginal injury, postpartum haemorrhage, blood transfusion, sepsis, admission to ITU, engrossing of stay
Neonate: ITU
What is a fetal pillow?
Balloon device designed to gently lift the baby’s head, making the delivery easier and safer, reducing risks and complications
Methods, other than the fetal balloon available for disimpaction of fetal head from pelvis
Use of non-dominant hand Walking towards anaesthetist Vaginal disimpaction Reverse breech extraction Tocolytics
Describe engagement
Fetal head enters the pelvic inlet in an occipitotransverse position
Transverse diameter of the inlet is greater than the anteroposterior diameter
Describe descent and flexion
The head descends into the mid-cavity and flexes as the cervix dilates
Describe internal rotation
In mid-cavity the fetal head rotates through 90° into occipitoanterior (OA) position, remaining flexed.
When this doesn’t happen, or the head rotates OP prolonged or obstructed labour can occur.
Might require rotation of the baby, operative vaginal delivery or c section
Further descent, extension and delivery
Head descends beyond ischial spines and the perineum descends
The head descends as it is delivered
Describe external rotation
Following the delivery of the head, the fetus rotates back to an OT position along with its shoulders. Axial traction is applied to allow delivery of the anterior shoulder, and then posterior soldier
Decelerations on a CTG
Reassuring
- none or early
- variable decelerations with no concerning features for <90 mins
Non-reassuring
- above >90 mins
- variable with concerning characteristics for up to 30 minutes (or more if present in <50% contractions)
- late decelerations <30mins
Abnormal
- late >30 mins
- variable >50% for 30 mins
- acute bradycardia or single prolonged deceleration for 3 mins or more
Indications for emergency c section
Cord prolapse Failure to progress Foetal distress in 1sr stage Anteparting haemorrhage Transverse lie in labour
