Instrumental Delivery Flashcards
What are the indications for instrumental delivery
- maternal: distress\exhausted - CVD\Pulmonary - prolonged 2nd stage
- fetal: distress -preterm - breech delivery
What are prerequisites of instrumental delivery
1- engaged head, known position of head\attitude.
2- evaluated pelvis, emptied bladder, dilated cervix
3- analgesia\consent\skill\ backup plan
Define engagement:
Passage of the largest diameter of the presenting part in (inlet)
- cephalic: biparital
- breech: bi-trochantric
What is the position and attitude of the head
- position: occipto (ant, post,transverse)
- attitude: flexed, extended or hyperextended
What is the favorable head position and attitude
Position: occipitoanterior
Attitude: flexed
Why does the cervix have to be dilated when using instrument
To avoid injury and laceration to the cervix
What do we mean by backup plan in instrumental delivery
Going to c-section
Never use two instruments at the same time
What are the absolute contraindications in instrumental delivery
1-lack of engagement & high head (unable to diagnose position)
2- CPD
3- malpresentation
4- unable to apply instrument
What are the relative contraindications in instrumental delivery
1- Macroscomia\CPD
2- higher station
3- proficiency and experience
What are the types of instruments?
1- vacuum extractor
2- forceps
What is the currently vacumm extractor
Kiwi (doesnt need to be connected to electricity, handy and less traumatic)
How to choose between forceps and vacumm?
Foreceps: traction + rotation
Vacumm: traction
What is the technique for using the vacum
1- patient is dilated 2- head flexed 3- push during contraction 2x force 4- after release remove the vacumm 5- episiotomy
What are the parts of forceps in instrumental delivery
1- toe, blade, shanck, lock & handle
2- cephalic and pelvic curve
Sphincter defects are more common with
Forceps or vacuum
Foreceps
Cephalhematoma are more common with
Forceps or vacuum
Vacum
What is a serious, and rare complication of using forceps
Intracranial hemorrhage
Which one is more likley to have more failure rates?
Forceps or vacuum
Vacumm
What are the complications of using instrumenst?
1- sphincter defect
2- cephalhematoma and intracranial hemorrhage
3- cervical\vagina\uterine tears
4- bladder\uretheral\rectal injury
5- fetal fascial palsies\or brachial plexus
6- fistula\postpartum urinary retention
Why is the maternal morbidity associated with CS is more than mortality associated with vaginal delivery?
1- infection
2- hemorrhage
3- thromboembolism
What are the indications of CS?
What are the absolute ones
1- dystocia
2- prev. CS (2 or 3)
3- fetal distress
4- (breech)
ABSOLUTE:
- footling presentation
- Full thickness, non-transverse, incision in myometrium
Why is repeat C\S is an indication for C\s
To avoid uterine rupture
What are the avoided incision in C\S
Classical and low vertical C\S
Why are classical and low vertical C-sections are to be avoided?
Because high vascular are and very difficult to repare
What is the most commonly used CS?
The low transverse
When do we go for low vertical suture in C\S?
In preterm delivery because the lower segment is not formed yet (before 36w)
What is important to be done in low transverse C\S
Do bladder flap to
How to reduce the risk of C\S?
-By external cephalic version of breech
(From 36-37w)
- By VBAC
