Labour - Operative interventions Flashcards
Options for delivery with history of previous C/S
Vaginal birth after Caesarean (VBAC)
- Advantages over ERCS
- Risks
Vaginal birth after Caesarean (VBAC)
Outcome
C/I
Elective repeat Caesarean section (ERCS)
Advantages and risks
Episiotomy
- Definition
- Indications
Episiotomy
Procedure
Complications
Perineal tears
Risk factors
Grading
Risk factors: larger infants, prolonged labor, instrumental delivery
Perineal tear
Management for each degree
Anal sphincter tear
Risk factors
Anal sphincter tear
Complications
Management
Instrumental vaginal delivery
Definition
Options
Indications
Instrumental delivery
Advantages of vaccuum extraction and forceps delivery
Instrumental delivery
Types of instruments
Instrumental delivery
When to abandon instrumental delivery
Risk of prolonged intrumental delivery
Instrumental delivery
Management of failed instrumental delivery
Instrumental delivery
Complications
Caesarean section
Indications
Caesarean section
Types of laparotomy and hysterotomy
Laparotomy
Pfannenstiel incision: ↑cosmesis, ↓analgesic requirements, ↑wound strength
- transverse curvilinear incision 2FB above pubic symphysis extending from and to points lateral to lateral margins of rectus abdominis
Infra-umbilical incision (alternative): used in case of extreme obesity, suspicion of other intra-abd pathology necessitating surgical intervention, or when access to fundus is required
- midline incision extending from lower border of umbilicus to symphysis pubis ± extension caudally to xiphisternum
Hysterotomy:
- Lower segment uterine incision (Kerr’s incision): used in >95% due to ease of repair, ↓blood loss, ↓risk of rupture/dehiscence in future pregnancies
- Classical incision (vertical)
- Lower vertical incision
Uterine incision extensions: done when transverse incision inadequate
- J extension: extension from one end to lateral fundus
- inverted T extension: addition of classical incision
- U extension: bilateral J extension
Caesarean section
Indications for classical C/S (uterine incision in midline)
Caesarean section
Management after delivery of baby
Caesarean section
Immediate complications
Caesarean section
Post-operative/ Long-term complications
