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Reproductive Health > Operative delivery > Flashcards

Operative delivery Flashcards

1
Q

Types of instrumental delivery

A

Ventouse suction cup or forceps

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2
Q

What give after forceps delivery

A

Co-amoxiclav

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3
Q

Indications for instrumental delivery

A

Failure to progress
Foetal distress
Maternal exhaustion
Control of head in various foetal positions

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4
Q

What procedure increases the risk of need for instrumental delivery?

A

Epidural

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5
Q

Risks of instrumental delivery to mother

A

PPH
Episiotomy
Perineal tears
Injury to anal sphinctre
Incontinence of bladder or bowel
Obturator or femoral nerve injury

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6
Q

Key risks to baby with instrumental delivery

A

Cephalohaemoatoma = collection blood between scalp and skull - with a ventouse
Facial nerve palsy - forceps

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7
Q

Rare serious risks to baby with instrumental delivery

A

Subgaleal haemorrahge - most dangerous
Intracranial haemorrhage
Skull fracture
Spinal cord injury

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8
Q

What is a subgaleal haemorrhage?

A

Accumulation of blood in layers soft tissue head between
Galea aponeuritica and
Periosteum

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9
Q

What is galea aponeuritica?

A

Tough fibrous connective tissue

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10
Q

What is periosteum

A

Membrane tissue that covers the surface of a newborns skull

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11
Q

What causes subgaleal haemoatoma?

A

When emissary veins passing thrpugh foramen seperate from the tissue and rupture during difficult vaginal delivery

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12
Q

Why is subgaleal haemotoma so life threatening?

A

Baby can lost 20% to 40% blood volume as haemorrhage forms in their skull

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13
Q

Management of subgaleal haemotoma

A

Blood and plasma transufion on NICU
Surgery to stop bleed if still clinically unwell
Normally resolves after 2-3 weeks

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14
Q

What is a ventouse?

A

On babies head, doctor or midwife applies careful traction to cord

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15
Q

What causes femoral nerve injury in forceps delivery?

A

Compressed against inguinal canal

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16
Q

What does femoral nerve injury cause?

A

Weakness of knee extension
Loss of patella reflec and numbness of anterior thigh and medial lower leg

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17
Q

What causes obturator nerve injury in forceps delivery?

A

Compressed by forceps or by foetal head in normal delviery

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18
Q

What does obturator nerve injury cause?

A

Weak hip adduction and rotation and numbness of medial thigh

18
Q

What does obturator nerve injury cause?

A

Weak hip adduction and rotation and numbness of medial thigh

19
Q

Nerve injuries that can occur in birth

A

Normal or instrumental
Obturator
Femoral
Lateral cutaneous nerve of the thigh
Lumbosacral plexus
Common peroneal nerve

20
Q

What does damage to lateral cutaneous nerve of thigh in birth cause?

A

Prolonged flexion at hip while lithotomy position can result in injury -> numbness of anterolateral thigh

21
Q

How is the lumbosacral plexus injured in birth and what does it cause?

A

May be compressed by foetal head during second stage of labour
Injury causes foot drop and numbness of anterolateral thigh, lower leg and foot drop

22
Q

What causes common peroneal injury in birth and what does this cause?

A

Compressed on head of fibula
Injury -> foot drop and numbness in lateral lower leg

23
Q

Indications for elective C section

A

Prev caesarean
Symptomatic after prev significant perineal tear
Placenta previa
Vasa previa
Breech
Multiple pregnancy
Uncontrolled HIV infection
Cervical cancer

24
Q

Categories of emergnecy C section

A

Category 1 - 4
1 - immediate threat to life of mother or baby - 30 mins
Category 2 - required urgently due to compromise - 75 mins
3 - delivery required, mother and baby stable
4 - elective C section

25
Q

Different types of incision

A

Pfannenstiel incision - curved, two fingers above pubic symphysis
Joel-cohens incision - straight incision slightly higher - recommended
Vertical incision - prem, anterior placenta previa
Blunt incision

26
Q

Why is blunt dissection used

A

After initial incision with scalpel
Seperate remaining layers of abdominal wall and uterus
Less bleeding, shorter operating times and less risk of injury to baby

27
Q

Layers of abdomen need to be dissected during C section

A

Skin
SC tissue
Fascia/rectus sheath
Rectus abdominis muslces
Peritoneum
Vesicouterine peritoneum
Uterus
Amniotic sac

28
Q

What is teh fascia/rectus sheath is

A

Aponeurosis of transversus abdominis and external and interal oblique muscles

29
Q

Layers of the uterus

A

Perimetrium, myometrium and endometrium

30
Q

What is the vesicouterine peritoneum

A

Bladder seperated from uterus bladder flap

31
Q

How is baby helped to be delivered

A

Assistance of pressure on the fundus

32
Q

What is exteriosrisation?

A

Uterus out of abdomen

33
Q

Risks ass with general anaesthetic

A

Allergic reactions or anaphylaxis
Hypotension
Headache
URINARY retention
-spinal anaesthetic
Nerve damage
Haematoma
-General anaesthetic
Sore throat
Damage to teeth or mouth

34
Q

Meds to reduce risk during a C section

A

H2 recpetor antagonists eg ranitidine or proton pump inhibirors eg omeprazole before
Prophylactiv antibiotics during
Oxytocin during - reduce PPH risk
VTE - prophylacis with LMW heparin

35
Q

What does H2 receptor antagonists or PPIs reduce the risk of in C section

A

Risk of aspiration penumonitis - acid reflux and aspiration during prolonged period lying

36
Q

Generic surgical risks C section

A

Bleeding
Infection
Pain
VTE

37
Q

Complications in PP period

A

PPH
Wound infection
Wound dehiscence
Endometriosis

38
Q

What local structures can be damaged in a C section

A

Ureter
Bladder
Bowel
Blood vessels

39
Q

What effects can have on abdominal organs C section

A

Ileus
Adhesions
Hernias

40
Q

What eIncreased riskss on future pregnancies have with C section

A

Repeat caesarean
Uterine rupture
Placenta previa
Stillbirth

41
Q

Effects on baby of C section

A

Lacerations
Transient tachypnoea of newborn

42
Q

Contraindications for vaginal birth after C section

A

Prev uterine rupture
Classical caesarean scar - vertical incision
Other usual contraindications to vaginal delivery

43
Q

Prophylaxis for VTE after C section

A

VTE risk assessment
Early mobilisation
Anti-embolism stocking or intermittent pneumatic compression of legs
LMW heparin

Reproductive Health (69 decks)

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