Lecture 15: Operative Delivery Flashcards
Operative vaginal delivery using vacuum extractor or forceps should only be performed if there is immediate ability to do what?
Perform C-section in case the procedure fails!
What are maternal indications for use of operative vaginal delivery?
- Mother is exhausted/lack of expulsive effort
- Inability to have expulsive effort: spinal cord injuries or neuromuscular disorders (i.e., MS)
- Need to avoid maternal expulsive efforts: certain cardiac conditions (i.e., aortic stenosis) or CVD (i.e., aneurysm or brain tumor)
What is the fetal indication for performing operative vaginal delivery?
Non-reassuring fetal status (i.e., bradycardia, repetitive HR decelerations)
What qualifies as prolonged 2nd stage of labor in a nulliparous vs. multiparous woman that would be an indication for operative vaginal delivery?
- Nulliparous: >2 hours w/o regional anesthesia or >3 hours with
- Multiparous: >1 hour w/o regional anesthesia or >2 hours with
What are 4 maternal criteria that must be met if you are to perform operative vaginal delivery?
- Adequate analgesia
- Lithotomy position
- Bladder empty
- Verbal or written consent
What are 4 fetal criteria that must be met if you are to perform operative vaginal delivery?
- Vertex presentation
- Fetal head MUST be engaged (biparietal diameter at 0 station)
- Position of fetal head MUST be known w/ certainty
- Station of the fetal head must be >+2
What are 3 uteroplacental criteria that must be met if you are to perform operative vaginal delivery?
- Cervix fully dilated
- Membranes ruptured
- NO placenta previa
What are 5 maternal complications which can occur with forceps delivery?
- Laceration of the vagina/cervix
- Episiotomy extension
- Pelvic hematomas
- Urethral and bladder injuries
- Uterine rupture
What are 6 fetal complications which can occur with forceps delivery?
- Minor facial lacerations
- Forceps marks
- Facial and brachial plexus injuries
- Skull fractures
- Intracranial hemorrhage
- Seizures
The indications and requirments for using vacuum assisted vaginal delivery are the same as using forceps, except, what is one advantage?
Delivery can be achieved w/ little maternal analgesia!
What are 4 containdications to using vacuum assisted vaginal delivery?
- Gestational age <34 wks
- Suspected fetal coagulation disorder
- Suspected feta macrosomia
- Breech presentation
Where should the cup of a vacuum assisted vaginal device be placed on the infants head?
Midline of the sagittal suture
How do the complications of using vacuum assisted vaginal extractors compar to that of forceps?
- More failed deliveries with vacuums
- Fewer perineal injuries to mother
- ↑ incidence of fetal caphalohematoma
- More scalp lacerations and bruising
What are 6 fetal indications for doing a C-section?
- Non-reassuring fetal HR
- Breech presentation/transverse presentation
- Very low birth weight (<1500 grams)
- Active herpes simplex virus infection
- Immune thrombocytopenia
- Congenital anomalies (i.e., gastroschisis, spina bifida)
What are 4 maternal-fetal indications for doing a C-section?
- Cephalopelvic disproportion (kids too big)
- Failure to progress
- Placental abruption
- Placenta previa (other placental position abnormalities like vasa previa)
What are 6 maternal indications for C-section?
- Obstructive benign and malignant tumors
- Large vuvlar condyloma
- Abdominal cervial cerclage
- Prior vaginal colporrhaphy
- Conjoined twins
- Maternal request
What are 7 intraoperative C-section complications?
- Uterine artery lacerations
- Bladder injuries
- Ureteral injuries
- GI tract injury
- Uterine atony
- Placenta accreta
- Cesarean hysterectomy
What are 6 post-op complications of C-section?
- Endomyometritis (infection of uterus)
- Wound complications: infection, separation, dehiscence
- Urinary complications (retention, infection)
- GI complications (ileus, diarrhea)
- Thromboembolic disorders (pulmonary emboli/DVT)
- Septic pelvic thrombophlebitis (most commonly of ovarian v.)
