Intrapartum Care: Operative Delivery Flashcards
What is operative vaginal delivery
Use of instruments to delivery foetus
How many attempts are you allowed with instruments
3 attempts
What are 3 maternal indications for operative delivery
- Exhaustion
- Co-morbidities
- Inadequate progress
What are 2 foetal indications for instrumental delivery
- Suspected foetal compromise
- Clinical concerns (eg. antepartum haemorrhage)
What are 4 absolute contraindications for instrumental delivery
- Breech
- Cephalo-pelvic disproportion
- Incompletely dilated cervix
- Unengaged head
What are 2 absolute contraindications of ventouse delivery
<34W
Coagulation abnormalities
What is a mnemonic to remember requirements of operative delivery
FORCEPS
What are requirements for operative delivery
Fully-dilated cervix Obstruction excluded Ruptured membranes Consent, catheterise Epidural Position Station, senior help
What are two instruments used in operative deliveries
Ventous
Forceps
What is a ventouse
Suction cup is applied to babies head via vacuum
What type of venous can be used for all foetal positions
Kiwi
Where is the venous applied
Flexion point
What is the flexion point
Midline, 3cm anterior to the posterior fontanelle
What are two advantages of ventouse
- Decrease incidence 3rd and 4th degree tears
- Perform with less knowledge about babies head
What are 4 disadvantages of ventouse
- Cephalohaematoma
- Lower success rate
- Increases subgleal haemorrhage
- Increases foetal retinal haemorrhage
What 3 complications does ventouse increase risk of
- Cephalohaematoma
- Subgleal haemorrhage
- Retinal haemorrhage
What is subgleal haemorrhage
bleeding between smbgaleal aponeurosis and periosteum
What forceps are used for ocipito-anterior posterior
Rhodes
Simpsons
Neville-Barnes
What forceps are used for C-section
Wrigley’s
What is the advantage of forceps
Higher success rate
Does not require maternal effort
What are 4 complications of forceps
Caput succedum
Facial nerve palsy
Soft-tissue scalp trauma
Higher rate tears
What is caput succedaneum
Oedema of the scalp
How does caput succedaneum present
- Swelling present at birth
- More common over the vertex
- Crosses suture lines
- Resolves in days
Where does caput succedaneum form
Vertex
What is the relationship between caput succedaneum and suture lines
crosses suture lines
When does caput succedaneum resolve
Within days
What is a cephalohaematoma
Collection of blood between periosteum and skull
Describe presentation of cephalohaematoma
Swelling parental region that appears hours after birth and does not cross suture lines
Does cephalohaematoma cross suture lines
No
What is often associated with cephalohaematoma
Jaundice
How long does cephalohaematoma take to resolve
3-months
How are c-sections classified
Category 1-4
What is a category 1 c-section
Emergency = Immediate threat to maternal or foetal life
How soon should a foetus be delivered in category 1 c-section
30 minutes
What is a category 2 c-section
Compromise, but no immediate threat to maternal or foetal life
What is the time frame to deliver category 2 c-section
60-75m
What is category 3 c-section
Early delivery
What is category 4 c-section
Elective
When are elective C-sections usually planned for and why
> 39W to reduce respiratory distress
What is mendelson’s syndrome
aspiration of gastric acid during pregnancy
What is given during LSCS to prevent mendelsons syndrome
ranitidine and pro-kinetic antiemetic (metclopramide)
What position is a women put in for C-section
left lateral at 15’
Why is women put in left-lateral position
to prevent aorta-caval syndrome: compression of abdominal aorta and IVC by uterus
What incisions are made for c-section
Pfannistiel or Joel-cohen
What is given to aid delivery of placenta following c-section
Oxytocin
What is an immediate complication of c-section
PPH
Wound haematoma
Intra-abdominal haemorrhage
Bladder/Bowel perforation
TTN
What are intermediate complications of c-section
Infection
What are long-term complications of c-section
VBAC Scar Psychological Future placenta praevia Sub-fertility: takes a longer time to get pregnant again
What are the two options for women who has had a previous C-Section
- Elective c-section
2. VBAC
What do RCOG say about VBAC
vaginal deliveries are safe for women who have had one previous c-section. With success rates of 72-75%
What is the most concerning risk of VBAC
Uterine rupture
What does c-section increase risk of
Transient Tachypnoea newborn
Define uterine rupture
Rupture uterine muscle and overlying serosa
What is the biggest risk factor for uterine rupture
Previous C-Section
What type of c-section has the highest risk of uterine rupture
Classical scar
What are 6 risk factors for uterine rupture
- C-section
- Uterine surgery
- Obstruction labour
- Multiparous
- Multiple pregnancy
- Induction with prostaglandins
What should be avoided in VBAC
Inducing labour
What are two absolute contriandications to VBAC
- Classical C-section
2. Previous uterine rupture
What is a relative contraindication to VBAC
More than 2 c-sections
What is an episiotomy
surgical incision to increase diameter of vaginal Introits
When may episiotomy be required
Complicated vaginal delivery - ventouse or forceps
FGM
Explain episiotomy procedure and why
Scissors used to cut laterally to posterior fourchette to prevent tearing of anal sphincter
What tissues are cut in episiotomy
Vaginal epithelium
Perineum
Bulbocavernousus muscle
Superficial, deep and transverse muscles
What should be performed after an episiotomy
Rectal exam - to check rectal mucosa intact
What may be given as analgesia post episiotomy
Rectal diclofenac
What is oxytocin used for in labour
Induction
Active management third stage
What is the MOA of oxytocin
Stimulate uterine contractions
What are prostaglandins used for
Induce labour
What is the MOA of prostaglandins
Increase cervical effacement and uterine contraction
What can be used to prevent premature labour
Terbutaline or salbutamol (B2 agonist)
