Operative deliv Flashcards
VAVD vs forceps
VAVD- more likely to fail
Forceps- more like for OASIS
NO difference in urinary incontiene or anal sphincter injury
VAVD or forceps- more likely to cause cephalohematoma
no difference in cephalohematoma
describe how to place kiwi
cup should be 2cm anterior to posterior fontanelle (triangle) and centered over sagittal suture
describe how to place forceps
posterior fontanelle is one finger breadth above shanks. sagittal suture is aligned
why no epis with all operative deliv? midline vs mediolateral epis risks
NO DATA to support routine epis.
RISKS
mediolateral- poor healing and prolonged discomfort
medial- inc risk of OASIS
risk of OASIS with kiwi vs forceps
FAFD- 6 fold
VAVD- 2 fold
what does data say about OASIS in operative deliv vs CD vs SVD
no difference in long term pelvic floor fxn in pt with operative deliv vs CD
If no anal sphincter lac, anal incontinence rates are similar to pt with SVD
newborn complications of operative deliv
VAVD- scalp lac, cephalohematoma, subgaleal/intracranial hemorrhage
forceps- facial lac, facial nerve injury, corneal abrasion, fracture, intracranial hemorrhage
does CD save my baby from injury when compared to operative deliv?
NO. some injuries are assc with indication of deliv and not so much operative delivery– CD does not lessen these risks
similar rate of neonatal death and encephalopathy
subgaleal hemorrhage vs cephalohematoma
- subgaleal hemorrhage- from rupture of emissary vs above periosteum, can cross suture lines. expandable and more dangerous
- cephalohematoma- underneath periosteum, does not cross suture lines. self limited
how are long term neonatal outcomes with operative deliv?
long term outcomes of operative deliv are equivalent to SVD
is there inc risk of operative deliv with macrosomic babies?
NO. risk of persistence injury with babies >4kg was not different in SVD vs operative deliv.
250+ elective CD would have to be performed for macrosomia to prevent a single case of persistent injury
when is operative deliv contraindicated? (4)
- fetal head unengaged
- position of head unk
- bone demineralization disorder
- bleeding disorder
what is the assc risk of CD after failed operative deliv? when should we abandon attempts for operative deliv?
studies are mixed and few BUT…
inc rates of cerebral hemorrhage, ventilation, and seizures
ABANDON if no descent with traction
why don’t we move to forceps if kiwi doesn’t work?
inc incidence of intracranial hemorrhage and severe perineal lacs
what type of forceps are used for rotational maneuvers?
Kielland- straight without pelvic curve
