lecture 6: operative delivery, wootten

Question 1

2 categories of operative vaginal delivery (OVD)

Answer 1

vaginal: forceps assisted, vacuum extracted

Cesarean delivery

Question 2

maternal indications operative vaginal delivery

Answer 2

maternal exhaustion

inability to have expulsive effort: spinal cord injury, neuromuscular disorder

need to avoid maternal expulsive efforts

• cardiac conditions, aortic stensois
• cerebrovascular disease

Question 3

fetal indications for operative vag delivery

Answer 3

non reassuring fetal status (bradycardia, repetitive heart rate decelerations)

other indications: prolonged 2nd stage labor
nulliparous: over 2 hours without anesthesis
or 3 hours with regional anestesia

Question 4

prereqs for OVD (operative vaginal delivery) maternal criteria

Answer 4

adequate analgestia
lithotomy position
bladder empty
consent

Question 5

fetal crietria OVD

Answer 5

vertex presentation
head position must be known and engaged
station of fetal head must be > +2

Question 6

uteroplacental criteria OVD

Answer 6

cervix fully dilated
membranes ruptured
no placenta previa

Question 7

scalp visible at introitus without separating labia
fetal skul reached pelvic floor
sagittal suture in AP diameter or left or right occpitu anterior or posterior position
fetal head at perineum
rotation does not exceed 45 degrees

type of vaginal delivery?

Answer 7

outlet operative vaginal delivery

Question 8

leading pt of the fetal head is at a +2 station or more and is not on pelvic floor
type of vaginal delivery?

Answer 8

low operative vaginal delivery

Question 9

fetal skull is above +2 station
not ever indicated today
type of vaginal delivery?

Answer 9

midpelvis and high forceps operative vaginal delivery

Question 10

forceps blade placement and direction of pull

Answer 10

cover space btwn orbits and ears

traction is applied in plane of least resistance and follows pelvic curve, if it doesn’t come easy, stop

Question 11

maternal complications of forcep delivery

Answer 11

pelvic hematoma
uterine rupture
episiotomy extension

rest are obvious

Question 12

what is the advantage of vacuum vs forceps

Answer 12

can be achieved with little maternal analgesia

Question 13

contraindications in vacuum assisted vaginal delivery

Answer 13

gestational age less than 34 weeks
suspected fetal coag disorder
suspected fetal macrosomia
breech presentation

Question 14

correct placement of vacuum

Answer 14

middle of posterior fontanelle or anterior fontanelle

Question 15

vacuum should not be applied for longer than

Answer 15

20 minutes

Question 16

vacuum comparison of complications to forceps

Answer 16

more failed deliveries with vacuums
fewer perineal injuries
increased incidence fetal cephalohematoma
more scalp lacerations and bruising

Question 17

which C section incision is used the most

Answer 17

pfannenstiel which is just suprapubic

Question 18

if kid is more than ____ grams dont deliver vaginally

Answer 18

4000

Question 19

info needed before making decision on C section

Answer 19

does she have epidural, bladder drained, position of kid etc

Question 20

c section intraoperative complication laundry list

Answer 20

uterine a laceration
bladder injury 
ureteral injury
GI tract injury
uterine atony
placenta accreta

Question 21

woman in active labor. changed to 6 cm and has not changed cervix for the last 6 hours despite adequate contractions, what do you do?

Answer 21

C section