OBN: Operative Vaginal Delivery

Question 1

____ (sign of placental separation) where the uterus becomes globular and firmer

Answer 1

calkin’s sign

Question 2

____degree of birth canal laceration where the fascia, muscles of the perineal body, and external anal sphincter are included

Answer 2

Third Degree

Question 3

___ degree of birth canal laceration where the fourchette, perineal skin, and vaginal mucus membran is included

Answer 3

First Degree

Question 4

Cite the signs of placental separation in order

Answer 4

1. Uterus becomes globular and firmer
2. Sudden gush of blood
3. Uterus rises in the abdomen
4. Lengthening of the umbilical cord

Question 5

____ degree of birth canal laceration where it extends to the rectal mucosa

Answer 5

Fourth degree

Question 6

__ degree of birth canal laceration where the fourchette, perineal skin, vaginal mucous membrane, fascia of the muscles of the perineal body are included

Answer 6

second degree

Question 7

Name 4 indications of cesarean delivery

Answer 7

1. Previous CS
2. Labor dystocia
3. Fetal distress
4. Breech presentation

Question 8

___ rupture rate of previous classical incision

Answer 8

2-9%

Question 9

___ rupture rate if with prior uterine rupture at upper uterus

Answer 9

9-32%

Question 10

___ rupture rate of previous T-shaped incision

Answer 10

4-9%

Question 11

___ rupture rate for s/p 2 CS if attempting trial of labor

Answer 11

1.8%. Otherwise, 0.0-1.8%

for s/p 1 CS 0.9% if attempting trial of labor otherwise 0.2 to 0.9%

Question 12

Factors considering VBAC (name 7)

Answer 12

1. 1-2 previous CS
2. No other uterine scars
3. Previous scar 18 months old
4. Adequate pelvis
5. Double setup available
6. Previous indication for CS absent
7. Cephalic presentation

Question 13

Prior to operative vaginal delivery, one must ensure

Answer 13

1. Fully dilated
2. Membranes ruptire
3. Adequate pelvis
4. Know the station, position

Question 14

What are the indications for operative vaginal delivery in nulliparous woman?

Answer 14

Lack of progress

1. > 3 hours with regional anesthesia
2. > 2 hours without regional anesthesia
3. suspicion of immediate or potential fetal compromise
4. shortening 2nd stage for maternal benefit

Question 15

What are the indications for operative vaginal delivery in multiiparous woman?

Answer 15

Lack of progress

1. > 2hours with regional anesthesia
2. > 1 hour without regional anesthesia
3. suspicion of immediate or potential fetal compromise
4. shortening 2nd stage for maternal benefit

Question 16

What are your criteria for outlet forceps delivery?

Answer 16

1. Scalp is visible at introitus without separating
2. Fetal skull has reached pelvic floor
3. Sagittal suture is in AP diameter or ROA/LOA or ROP/LOP
4. Fetal head is at or on perineum
5. Rotation does not exceed 45 degreees

Question 17

What can you do if satisfactory application of forceps cannot be achieved failed forceps delivery?

Answer 17

Abandon procedure. Deliver via

1. Vacuum extraction
2. CS

Question 18

What will you do if application of forceps was achieved but downward pull do not result in descent?

Answer 18

Abandom procedure

deliver via CS

Question 19

In applying the forceps, the left hand should hold the ___ blade of the forceps and insert it vertically

Answer 19

Left blade

Left hand = left blade = maternal left

Question 20

In forceps delivery, what fontanelle should be 1 cm above the plane of shank?

Answer 20

posterior fontanelle