operative delivery Flashcards
What are the indications for operative vaginal delivery?
Maternal
- exhaustion/fatigue
- cardiovascular + intracranial disease
- prolonged second stage of labour
Fetal
- fetal compromise
- malpresentation (face & head coming after breech)
How long should we wait before using operative vaginal delivery techniques during the 2nd stage of labour?
Nulliparous
- without analgesia -> 3 hours
- with analgesia -> 4 hours
Multiparous
- without analgesia -> 2 hours
- with analgesia -> 3 hours
What are the factors that reduce assisted vaginal delivery?
1- one to one care
2- presence of birth partner
3- use of oxytocin in 2nd stage of labour
4- upright or lateral position
5- not putting arbitrary limits for 2nd stage
What are the requirements that should be available before the use of assisted vaginal delivery?
1- engaged head & vertex presentation
2- adequate pelvic dimensions
3- full cervical dilatation
4- exact position & attitude of fetal head should be known
5- amniotic membrane rupture
6- experienced operator
7- empty urinary bladder
8- willingness to abandon procedure in case of failure
What are the classifications of forceps delivery?
- outlet forceps -> fetal head on pelvic floor at perineum (scalp should be visible between contractions)
- low forceps -> leading edge is 2cm or more from ischial spine
- mid forceps -> leading edge is less than 0-2cm from ischial spine
How should ventose delivery be preformed?
1- cervix should be fully dilated
2- empty bladder
3- cup over flexion point & feel for maternal tissue between
4- gentle traction
5- episiotomy
6- when jaw is visible or reachable -> release the pressure to remove the cup
When should ventose delivery be halted (stopped)?
- if the cup detaches 3 times
- 3 pulls without progress
- 20 minutes passed since start of procedure
What are the contraindications to vacuum delivery?
1- prematurity <34 weeks risk of intracranial hemorrhage
2- not fully dilated cervix
3- non vertex presentation
4- fetal blood sampling
5- suspected cephalopelvic disproportion
What are the complications of vacuum assisted delivery?
Maternal
- anal sphincter injury
- postpartum hemorrhage
Fetal
- cephalohematoma
- subgaleal hematoma
- hyperbilirubinemia
What are the complications of forceps delivery?
- perineal tears (3rd & 4th degree) & anal sphincter injury
- urinary incontinence
- sexual dysfunction
- PPH due to perineal laceration
- Fetal injury: facial nerve palsy or clavicular fractures
What are the indications for C section?
Fetal
- abnormal FH tracing
- cord prolapse
- malpresentation
- HIV viral load >1000/ml
- active viral herpes infection
- congenital anomaly
- vasa Previa
Maternal Fetal
- placenta Previa
- placenta abruption
- failure to progress
- perimortem
- conjoined twins
Maternal
- repeat C section
- obstructive tumor
- medical conditions
- abdominal cerclage
- contracted pelvis
What are the most common causes of C section?
1- repeated scars
2- failure to progress
3- fetal compromise
4- fetal malpresentation
What are the categories of C section?
Category 1 -> immediate threat to life
Category 2 -> no immediate threat to life
Category 3 -> requires early delivery
Category 4 -> elective
When should a C section be scheduled?
Not before 39 weeks unless indicated in special conditions
How is a C section preformed?
1- anesthesia (epidural)
2- blood samples for CBC & cross matching
3- 1gm cefazolin IV
4- bladder catheterization
5- left lateral tilt
6- transverse or vertical incision
7- deliver baby & placenta
8- clean uterine cavity
9- close incision
