Lecture 15: Operative Delivery Flashcards

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1
Q

Operative vaginal delivery using vacuum extractor or forceps should only be performed if there is immediate ability to do what?

A

Perform C-section in case the procedure fails!

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2
Q

What are maternal indications for use of operative vaginal delivery?

A
  • 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)
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3
Q

What is the fetal indication for performing operative vaginal delivery?

A

Non-reassuring fetal status (i.e., bradycardia, repetitive HR decelerations)

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4
Q

What qualifies as prolonged 2nd stage of labor in a nulliparous vs. multiparous woman that would be an indication for operative vaginal delivery?

A
  • Nulliparous: >2 hours w/o regional anesthesia or >3 hours with
  • Multiparous: >1 hour w/o regional anesthesia or >2 hours with
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5
Q

What are 4 maternal criteria that must be met if you are to perform operative vaginal delivery?

A
  • Adequate analgesia
  • Lithotomy position
  • Bladder empty
  • Verbal or written consent
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6
Q

What are 4 fetal criteria that must be met if you are to perform operative vaginal delivery?

A
  • 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
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7
Q

What are 3 uteroplacental criteria that must be met if you are to perform operative vaginal delivery?

A
  • Cervix fully dilated
  • Membranes ruptured
  • NO placenta previa
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8
Q

What are 5 maternal complications which can occur with forceps delivery?

A
  • Laceration of the vagina/cervix
  • Episiotomy extension
  • Pelvic hematomas
  • Urethral and bladder injuries
  • Uterine rupture
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9
Q

What are 6 fetal complications which can occur with forceps delivery?

A
  • Minor facial lacerations
  • Forceps marks
  • Facial and brachial plexus injuries
  • Skull fractures
  • Intracranial hemorrhage
  • Seizures
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10
Q

The indications and requirments for using vacuum assisted vaginal delivery are the same as using forceps, except, what is one advantage?

A

Delivery can be achieved w/ little maternal analgesia!

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11
Q

What are 4 containdications to using vacuum assisted vaginal delivery?

A
  • Gestational age <34 wks
  • Suspected fetal coagulation disorder
  • Suspected feta macrosomia
  • Breech presentation
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12
Q

Where should the cup of a vacuum assisted vaginal device be placed on the infants head?

A

Midline of the sagittal suture

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13
Q

How do the complications of using vacuum assisted vaginal extractors compar to that of forceps?

A
  • More failed deliveries with vacuums
  • Fewer perineal injuries to mother
  • incidence of fetal caphalohematoma
  • More scalp lacerations and bruising
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14
Q

What are 6 fetal indications for doing a C-section?

A
  • 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)

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15
Q

What are 4 maternal-fetal indications for doing a C-section?

A
  • Cephalopelvic disproportion (kids too big)
  • Failure to progress
  • Placental abruption
  • Placenta previa (other placental position abnormalities like vasa previa)
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16
Q

What are 6 maternal indications for C-section?

A
  • Obstructive benign and malignant tumors
  • Large vuvlar condyloma
  • Abdominal cervial cerclage
  • Prior vaginal colporrhaphy
  • Conjoined twins
  • Maternal request
17
Q

What are 7 intraoperative C-section complications?

A
  • Uterine artery lacerations
  • Bladder injuries
  • Ureteral injuries
  • GI tract injury
  • Uterine atony
  • Placenta accreta
  • Cesarean hysterectomy
18
Q

What are 6 post-op complications of C-section?

A
  • 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.)