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Obstetrics > Intrapartum Care: Operative Delivery > Flashcards

Intrapartum Care: Operative Delivery Flashcards

1
Q

What is operative vaginal delivery

A

Use of instruments to delivery foetus

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2
Q

How many attempts are you allowed with instruments

A

3 attempts

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3
Q

What are 3 maternal indications for operative delivery

A
  • Exhaustion
  • Co-morbidities
  • Inadequate progress
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4
Q

What are 2 foetal indications for instrumental delivery

A
  • Suspected foetal compromise

- Clinical concerns (eg. antepartum haemorrhage)

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5
Q

What are 4 absolute contraindications for instrumental delivery

A
  1. Breech
  2. Cephalo-pelvic disproportion
  3. Incompletely dilated cervix
  4. Unengaged head
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6
Q

What are 2 absolute contraindications of ventouse delivery

A

<34W

Coagulation abnormalities

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7
Q

What is a mnemonic to remember requirements of operative delivery

A

FORCEPS

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8
Q

What are requirements for operative delivery

A 
Fully-dilated cervix 
Obstruction excluded
Ruptured membranes
Consent, catheterise 
Epidural
Position
Station, senior help
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9
Q

What are two instruments used in operative deliveries

A

Ventous

Forceps

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10
Q

What is a ventouse

A

Suction cup is applied to babies head via vacuum

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11
Q

What type of venous can be used for all foetal positions

A

Kiwi

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12
Q

Where is the venous applied

A

Flexion point

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13
Q

What is the flexion point

A

Midline, 3cm anterior to the posterior fontanelle

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14
Q

What are two advantages of ventouse

A
  • Decrease incidence 3rd and 4th degree tears

- Perform with less knowledge about babies head

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15
Q

What are 4 disadvantages of ventouse

A
  • Cephalohaematoma
  • Lower success rate
  • Increases subgleal haemorrhage
  • Increases foetal retinal haemorrhage
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16
Q

What 3 complications does ventouse increase risk of

A
  1. Cephalohaematoma
  2. Subgleal haemorrhage
  3. Retinal haemorrhage
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17
Q

What is subgleal haemorrhage

A

bleeding between smbgaleal aponeurosis and periosteum

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18
Q

What forceps are used for ocipito-anterior posterior

A

Rhodes
Simpsons
Neville-Barnes

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19
Q

What forceps are used for C-section

A

Wrigley’s

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20
Q

What is the advantage of forceps

A

Higher success rate

Does not require maternal effort

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21
Q

What are 4 complications of forceps

A

Caput succedum
Facial nerve palsy
Soft-tissue scalp trauma
Higher rate tears

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22
Q

What is caput succedaneum

A

Oedema of the scalp

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23
Q

How does caput succedaneum present

A
  • Swelling present at birth
  • More common over the vertex
  • Crosses suture lines
  • Resolves in days
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24
Q

Where does caput succedaneum form

A

Vertex

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25
Q

What is the relationship between caput succedaneum and suture lines

A

crosses suture lines

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26
Q

When does caput succedaneum resolve

A

Within days

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27
Q

What is a cephalohaematoma

A

Collection of blood between periosteum and skull

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28
Q

Describe presentation of cephalohaematoma

A

Swelling parental region that appears hours after birth and does not cross suture lines

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29
Q

Does cephalohaematoma cross suture lines

A

No

30
Q

What is often associated with cephalohaematoma

A

Jaundice

31
Q

How long does cephalohaematoma take to resolve

A

3-months

32
Q

How are c-sections classified

A

Category 1-4

33
Q

What is a category 1 c-section

A

Emergency = Immediate threat to maternal or foetal life

34
Q

How soon should a foetus be delivered in category 1 c-section

A

30 minutes

35
Q

What is a category 2 c-section

A

Compromise, but no immediate threat to maternal or foetal life

36
Q

What is the time frame to deliver category 2 c-section

A

60-75m

37
Q

What is category 3 c-section

A

Early delivery

38
Q

What is category 4 c-section

A

Elective

39
Q

When are elective C-sections usually planned for and why

A

> 39W to reduce respiratory distress

40
Q

What is mendelson’s syndrome

A

aspiration of gastric acid during pregnancy

41
Q

What is given during LSCS to prevent mendelsons syndrome

A

ranitidine and pro-kinetic antiemetic (metclopramide)

42
Q

What position is a women put in for C-section

A

left lateral at 15’

43
Q

Why is women put in left-lateral position

A

to prevent aorta-caval syndrome: compression of abdominal aorta and IVC by uterus

44
Q

What incisions are made for c-section

A

Pfannistiel or Joel-cohen

45
Q

What is given to aid delivery of placenta following c-section

A

Oxytocin

46
Q

What is an immediate complication of c-section

A

PPH
Wound haematoma
Intra-abdominal haemorrhage
Bladder/Bowel perforation

TTN

47
Q

What are intermediate complications of c-section

A

Infection

48
Q

What are long-term complications of c-section

A 
VBAC 
Scar
Psychological
Future placenta praevia 
Sub-fertility: takes a longer time to get pregnant again
49
Q

What are the two options for women who has had a previous C-Section

A
  1. Elective c-section

2. VBAC

50
Q

What do RCOG say about VBAC

A

vaginal deliveries are safe for women who have had one previous c-section. With success rates of 72-75%

51
Q

What is the most concerning risk of VBAC

A

Uterine rupture

52
Q

What does c-section increase risk of

A

Transient Tachypnoea newborn

53
Q

Define uterine rupture

A

Rupture uterine muscle and overlying serosa

54
Q

What is the biggest risk factor for uterine rupture

A

Previous C-Section

55
Q

What type of c-section has the highest risk of uterine rupture

A

Classical scar

56
Q

What are 6 risk factors for uterine rupture

A
  1. C-section
  2. Uterine surgery
  3. Obstruction labour
  4. Multiparous
  5. Multiple pregnancy
  6. Induction with prostaglandins
57
Q

What should be avoided in VBAC

A

Inducing labour

58
Q

What are two absolute contriandications to VBAC

A
  1. Classical C-section

2. Previous uterine rupture

59
Q

What is a relative contraindication to VBAC

A

More than 2 c-sections

60
Q

What is an episiotomy

A

surgical incision to increase diameter of vaginal Introits

61
Q

When may episiotomy be required

A

Complicated vaginal delivery - ventouse or forceps

FGM

62
Q

Explain episiotomy procedure and why

A

Scissors used to cut laterally to posterior fourchette to prevent tearing of anal sphincter

63
Q

What tissues are cut in episiotomy

A

Vaginal epithelium
Perineum
Bulbocavernousus muscle
Superficial, deep and transverse muscles

64
Q

What should be performed after an episiotomy

A

Rectal exam - to check rectal mucosa intact

65
Q

What may be given as analgesia post episiotomy

A

Rectal diclofenac

66
Q

What is oxytocin used for in labour

A

Induction

Active management third stage

67
Q

What is the MOA of oxytocin

A

Stimulate uterine contractions

68
Q

What are prostaglandins used for

A

Induce labour

69
Q

What is the MOA of prostaglandins

A

Increase cervical effacement and uterine contraction

70
Q

What can be used to prevent premature labour

A

Terbutaline or salbutamol (B2 agonist)

Obstetrics (27 decks)

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