OB Procedures Flashcards
types of forceps
simpson: most common
keilland: for mid-/high stations of the head
tucker-mclane
piper: breech
fetal indications for forceps delivery
non-reassuring heart rate pattern
premature placental separation
maternal indications for forceps delivery
heart disease pulmonary injury or compromise intrapartum infection neurological conditions maternal exhaustion and prolonged 2nd stage of labor
prerequisites to operational delivery
experienced operator engaged head ruptured membranes vertex presentation fully dilated cervix no cpd no fetal coagulopathy or bone demineralization disorder
abandon operative procedure if
satisfactory application of forceps cannot be achieved
application was achieved but downward pull does not result in descent
factors for failed forceps assisted delivery
persistent occiput posterior
absence of regional or general anesthesia
birth weight >4kg
preparation for mother and fetus before forceps procedure
fetus: fully dilated cervix, ruptured bag of waters, cephalic presentation, confirm fetal head position and station
mother: consent, anesthesia, empty bladder
forceps procedure steps
Ask for assistance Bladder empty Cervix fully dilated Determine station, position Equipment Forceps insertion Gentle traction Handle elevation Incision Jaw
maternal morbidities due to forceps procedure
3rd (EAS) and 4th (rectum) degree lacerations
vaginal and cervical laceration
urinary incontinence
anal incontinence
pelvic organ prolapse
urinary retention and bladder dysfunction
perinatal morbidities due to forceps/vaccum procedure
vaccum: cephalohematoma, subgaleal hemorrhage, retinal hemorrhage, neonatal jaundice, shoulder dystocia, clavicular fracture, scalp lacerations
forceps: facial nerve injury, brachial plexus injury, depressed skull fracture, corneal abrasion
classification of breech presentations
frank complete incomplete footling stargazer
how to decide on cs or vaginal delivery for breech
24-32 wks: planned cs better
32-37 wks: depends on fetal weight
vaginal breech if weight >2500 g
t/f for large fetus >3800-4000g, cs is perferred
true
presentations where cs is better
incomplete or footling breech
hyperextended head
three methods of breech delivery
spontaneous breech delivery
partial breech extraction
total breech extraction
cardinal rule in partial breech extraction
steady, gentle, downward traction until the lower halves of the scapulas are delivered, making no attempt at delivery of the shoulders and arms until one axilla becomes visible
maneuvers to deliver head
- maureiceau maneuver : fingers on maxilla to flex the head, downward action
- modified prague maneuver when fetal back down
- pipers forceps / divergent laufe forceps
maneuvers for trapped head
duhrssen incision: incision at 2:00 and 10:00 position iv nitroglycerin 100 ug general anesthesia zavanelli maneuver symphysiotomy
t/f the forceps blased are not applied until the aftercoming head has been brought into the pelvis by gentle traction, combined with suprapubic pressure and is engaged
true
maneuver where two fingers will push knee away from midline and spontaneous flexion of extremity follows
pinard maneuver used in
breech decomposition
t/f death is higher in planned cs deliveries for breech
true
t/f umbilical cord prolapse is more frequent in breech than cephalic
true
t/f hip dysplasia is more common in cephalic than breech
false
maneuvers where fetal presentation is altered by physical manipulation either by substituting one pole of a longitudinal presentation for the other, or converting an oblique or transverse lie into a longitudinal presentation
version, can be external or internal
