Instrumental and operative Flashcards
FORCEPS
fully dilated cervix
Occiput anterior
Rupture of membranes
cephalic presentation
engaged presenting part not palpable abdominally
pain relief
sphincter empty (catheter)
when is an instrumental delivery indicated
maternal exhaustion
foetal compromise
factors which make it unsafe for mother to keep pushing
prolonged second stage of labour
Maternal illness that makes SVD dangerous
- Cardiac disease
- HTN
- Aneurysm
- Glaucoma
- Prolonged second stage of labour
nulliparous women
- 2 hours (with epidural), 3 hours (without epidural)
Prolonged second stage of labour
multiparous women
- 1 hour (with epidural), 2 without in multiparity
what form of instrumental is better for mother
ventous
what instrumental delivery is worse / has more complications for mother?
Forceps
foetal complication of instrumental delivery?
cephalohaematoma
chignon
scalp laceration
facial nerve palsy / damage
neonatal jaundice
intracerebral haemorrhage
maternal complications?
- Vaginal laceration
- Blood loss
- Third degree tears
what is non rotational forceps?
○ Simpsons
○ Neville barnes
Only use if occiput is anterior
rotational forceps?
Kielland’s
Allow malpositioned head to be rotated by operator to OA
cephalohaematoma is when blood collects where?
sub-periosteal space
due to damage to blood vessels
(heals itself) noticed as a bulge
risks associated with c section?
- Haemorrhage
- Blood transfusion
- Infection
- VTE
- 1 in 5000 die
what is a prolonged first stage defined as?
> 12 hours not fully dilated
after ERCS when can you get pregnant?
not for 12-18 months
is thromboprophylaxis needed after a ERCS?
yes
what is success rate of VBAC?
biggest signifier of success?
72-75%
previous VBAC (successful)
contraindications to VBAC?
classical c section scar
uterine rupture
praevia
what are the risks associated with c section?
haemorrhage
Blood transfusion
infection
VTE
if head is OP what can you use to aid delivery?
Forceps - Kiellands
allows malpositioned head to be rotated
C section layers?
skin
fatrectus sheath
rectus muscle
peritoneum
abdominal cavity
loose peritoneum
lower segment
what thromboprophylaxis is used in pregnANCY?
LMWH
can a SVD be offered in placenta praevia?
yes ONLY if grade 1
conservative management for a worrying CTG ?
position - left lateral position)
consider tocolysis in uterine hyperstimulation
foetal scalp sample
7.2-7.25?
conservative measurements then reassess in 20-30 mins
foetal scalp sample <7.2?
c section
main complication of IoL?
uterine hyperstimulation
offer tocolysis?
what is uterine hyperstimulation?
what is it caused by?
high contraction frequency
and duration
>20 mins
so more than 4 every 10 mins
IoL - misoprostolol
what are the indications for IoL?
prolonged pregnancy
pprom
diabetic mother >38 weeks
pre-eclampsia
IHC of pregnancy
bishop score
cervical effacement? 3 points
80%
bishop score
cervical effacement?
2
60-70%
bishop score
cervical effacement?
1 point
40-60%
Bishop score
cervical dilation
1
2
3
1-2 cm
3-4cm
> 5cm
foetal station - bishops score
1- -2
2: -1/0 at ischial spines
3: +1,2 below spines
cervical position
0- posterior
1-intermediate
2-anterior
