Operative Birth Flashcards
What are the different types of forceps?
Neville-Barnes
Simpsons
Haigh-Ferguson’s
Keilland’s
Wrigley’s
What are the neville-BArnes forceps used for?
Presenting part is mid cavity in anterior occiput way (OA)
What are Simpsons forceps used for?
Moulding/elongation of fetal head
When are Haigh-Ferguson forceps used?
Mid cavity
When are Keilland’s forceps used?
Rotation- transverse or direct OP
When are Wrigley’s forceps used?
Lift out/low head/+2 or lower.
What is the name of the suction/vacuum?
Ventouse
What is the name of the abdominal operative delivery?
Caesarean section
What is the historical purpose of an instrumental birth?
To retrieve the infant from a dead or dying mother. Sadly, the operation was not intended to preserve the mother’s life.
What is the history behind the creation of forceps?
- The ‘modern’ incarnation of the forceps was developed by the Chamberlen family in 17th Century.
- The Chamberlens were innovators, opportunists and entrepreneurs who tried to promote various schemes for the public good, (and their own advancement).
- Dr Peter, in 1634, proposed a Sisterhood of Midwives of London.
- He would license midwives competence for which he would be paid a fee foreach delivery and would be called to all difficult cases.
- Developed the forceps c 1645, but kept the designs hidden until they were discovered in 1813!
What was the advanced progress of forceps in the early C18th with William Smellie?
Progress advanced in the early C18th with William Smellie.
In 1751 he accurately described the mechanism of parturition and the curves of the birth canal.
Set about designing his own instruments, with features which have endured to this day.
‘English lock’
the pelvic curve
shortened handles
Late C19th and early C20th saw further innovation with manufacturing techniques and materials (steel) and the development of the forceps we have today (Neville Barnes, Kielland (rotational).
What is the consent process for a operative delivery?
Name of proposed procedure or course of treatment
. The proposed procedure.
Intended benefits.
Serious and frequently occurring risks.
Any extra procedures which may become necessary during the procedure.
What the procedure is likely to involve.
The benefits and risks of any available alternative treatments, including no treatment.
Statement of patient: procedures which should not be carried out without further discussion.
Preoperative Information.
Anaesthesia
What are the two types of forcep births?
Non-rotational forceps:
-mid cavity forceps
-low cavity oulet/LSCS forceps
Rotational (Keillands) forceps:
-The reduced pelvic curve allows rotation.
What are the maternal indications for forceps?
-Prolonged second stage of labour
-Maternal exhaustion
-Prophylactic shortening of the second stage (managing and OP position)
What are the fetal indications for forceps?
Suspected fetal compromise in the second stage
-pathological CTG
-Abnormal FBS
What is a pundenal nerve block analgesia (PNB)?
- Used as pain relief in the final stage of childbirth.
- An option during the second stage of birth (from 10 cm to birth)during the final descent of the fetal head and expulsion of the baby.
- An effective method of pain relief, providing analgesia to the vulva and anus by transvaginal infiltration of the pudendal nerve.
- It may be provided in spontaneous as well as in instrumental (vacuum and/or forceps extraction) vaginal births.
- Also used as analgesia for the suturing of perineal lacerations after birth
What are the 3 p’s of examination?
Power, Passenger, Passage
What is the 3p: power of examination mean?
Strength / frequency of contractions (determined by abdominal palpation rather than looking at the CTG).
An oxytocin infusion may be required. What to do if abnormal CTG
What is the 3p: Passenger of examination?
Estimated size of baby
USS / Customised Growth Chart.
You should assess the presentation, position and station
What is the 3p: passage of examination?
Abdominal and vaginal examination.
<One-fifth palpable per abdomen
Fully?
Spines or below on vaginal examination (0 station).
Moulding? May be disproportion
what are some of the complications with forcep delivery?
- PPH* Perineal tears (1 in 10)
- Rare: persistent dyspareunia
- Third degree tears
- 2 - 20%
- 3.5% of women have long term faecal incontinence following forceps birth.
- Fetal bruising, grazing and chignon (Swelling generally caused by ventouse)
- Significant concern for women
- Jaundice
- Retinal and Intracranial haemorrhage
- Shoulder dystocia
What are the caesarean categories?
- Elective LSCS
- Carried out after 39 weeks.
- Daytime hours with dedicated team (inc midwife).
- Emergency LSCS categories:
- Immediate threat to the life of the woman or fetus
- Maternal or fetal compromise that is not immediately life-threatening
- No maternal or fetal compromise but needs early delivery
- Delivery timed to suit woman or staff
What are some indications for cesarean?
Elective
Fetal position eg Breech.
Previous LSCS.
Some twins, triplets.
Placental. Maternal infection.
Maternal – PET, active primary Herpes.
Fetal – Suspected fetal compromise in any stage of labour (pathological CTG, abnormal FBS), fetal disease
What needs to be done once a decision as been made?
- Note the decision time.
- Inform coordinator.
- Inform Anaesthetist.
- Inform Theatre team.
- Should be onsite, but backup team may be at home!
- Ensure blood tests.
- FBC, Clotting, G&S, (U&Es, LFTs).
- Inform Neonatal team (emergencies).
- Need to be present in theatre.
- Prepare the woman/birthing person to be moved to theatre.
What are some frequent maternal risks of a caesarean section?
- Persistent wound and abdominal discomfort in the first few months after surgery (9 in 100; common).
- Increased risk of repeat caesarean section for subsequent pregnancies (1 in 4;extremely common).
- Readmission to hospital (5 in 100 (common).
- Haemorrhage (5 in 1000; uncommon).
- Infection (6 in 100; common).
- Emotional distress/regret.
What are some serious maternal risks of a caesarean?
Emergency hysterectomy (7–8 in 1000; uncommon).
* Need for further surgery at a later date (5 in 1000; uncommon).
* Bladder injury (1 in 1000; rare).
* Ureteric injury (3 in 1000; rare).
* Death (approximately 1 in 12 000; extremely rare)
What are some fetal risks for a caesarean?
- Fetal injury lacerations (2.0% or 1–2 in 100; common).
- Admission to intensive care unit (0.9%)
What is the preparation needed for a caesarean
Team effort –Advocate women’s/birthing person’s wishes/requests
* The category will determine the urgency
* Cannula +/- Blood tests
* Antacid
* Catheter
* Essential before we can start the procedure
* May already be in situ or will need inserting in theatre
* Changing patient
* (And birthing partner)
* Notes/documentation
* Ongoing
* Moving to theatre
* May involve a lift or to another department.
What are some difficulties of a caesarean?
- Understanding.
- Of procedure.
- Language barrier.
- Inability for patient to cope.
- Pain (May need to convert to GA)
- Partner will have to leave theatre!* Distressing for the woman!
- Baby born in poor condition.
- Complications
