OnlineMedEd: Obstetrics - "OB Operations"

Question 1

Dustyn breaks down c-sections into three categories. List them and give the indications for each.

Answer 1

•Elective:

• Mom wants it
• Non-urgent indication (like breech presentation or multiple gestation)

•Urgent:

• Eclampsia
• Arrest of labor

•Emergent:

• Hemodynamic instability
• Fetal distress

Question 2

List two risks and one benefit of caesarian section.

Answer 2

• Risk: scar and VBAC

* Benefit: can due tubal ligation or gravid hysterectomy

Question 3

If a woman wants to do a VBAC, what should you assess?

Answer 3

The number and type of past sections:

• Two or fewer and all transverse? Ok!
• More than two or vertical cuts? Plan c-section.

Question 4

What is TOLAC?

Answer 4

Trial of labor after caesarian

Failing labor attempt after prior c-section

Question 5

What two criteria need to be met in order to do a forceps- or vacuum-assisted delivery?

Answer 5

• Total cervical effacement

* 2+ station or greater

Question 6

There are two situations in which forceps or vacuum are indicated: _____________.

Answer 6

fetal distress and arrest of labor

Question 7

There are three risks associated with forceps use: ________________.

Answer 7

cephalohematoma, Bell’s palsy, and denuding the vagina

Question 8

Explain the two types of episiotomies.

Answer 8

• Medial (straight from vagina to anus)
• Mediolateral (from vagina to lateral)

The medial type heals better but carries a risk of expanding to a larger cut. The mediolateral type heals more poorly but has no risk of expansion.

Question 9

List the four types of episiotomies.

Answer 9

• I: vagina only
• II: vagina and perineum
• III: vagina, perineum, and anal sphincter
• IV: vagina, perineum, anal sphincter, and anal mucosa

Question 10

What is cerclage?

Answer 10

Cerclage is a surgical suture in the cervix that is used to treat incompetent cervix. In a woman with an incompetent cervix, there is usually some reason it won’t close: past D&C, PID, or STIs. She will commonly have second-trimester miscarriages. Suturing it with cerclage can treat that.

Question 11

When are cerclages put in and taken out?

Answer 11

14 weeks and 36 weeks

Question 12

What happens if an epidural is given subdurally?

Answer 12

The lidocaine can cause life-threatening hypotension.

Question 13

Epidurals require what two additional things?

Answer 13

• Tocometer (because the mom won’t know she’s contracting)

* A coach (because the mom needs to push in conjunction with contractions)

Question 14

Cervical lidocaine blocks can cause ____________.

Answer 14

transient fetal bradycardia

Question 15

What kind of nerve blocks are given during delivery?

Answer 15

Pudendal nerve (near the ischial tuberosity)