Operative Delivery Flashcards
What are the foetal indications for operative vaginal delivery?
Presumed foetal compromise
What are the maternal indications for operative vaginal delivery?
Medical indications to avoid valsalva, e.g.
- cardiac disease
- hypertensive disease
- cerebrovascular disease
- myasthenia gravis
- spinal cord injury
What inadequate labour processes would indicate an operative vaginal delivery?
Nulliparous women (lack of progress for 3 hrs, or 2 hrs without anaesthesia)
Multiparous women (lack of progress for 2 hrs, or 1 hr without anaesthesia)
Maternal fatigue/exhaustion
What is operative vaginal delivery?
A delivery that requires use of instruments such as the:
- Ventouse or Forceps
What requirements are needed for an instrumental delivery?
Valid reason
Head must not be palpable abdominally
Head must be at or below level of ischial spines
Cervix must be dilated
Position of the foetal head must be known
Adequate analgesia
Empty bladder
C-section facilities in place if failure
What is a ventouse?
Cap fixed near 2-3 cm anterior to posterior fontanelle (flexion point) by suction
What are the different types of forceps?
Non-rotational = Neville-Barnes forceps
Rotational = Kielland’s forceps
Which foetal head position can the forceps or ventouse be used straight away?
Occipito-anterior
When should an operative delivery be abandoned?
If there is no evidence of progressive descent with each pull
If delivery is not imminent following three pulls of correctly applied instrument by experienced operator
What are the absolute indications for Emergency C-Section?
Placenta Praevia
Severe antenatal fetal compromise
Uncorrectable abnormal lie
Previous classical C-section
Pelvic deformity
What are the relative indications for Emergency C-Section?
Breech presentation
DM and other medical diseases
Previous C-sections
Older nulliparous women
What are the only two conditions for C-section prior to 34 weeks?
Severe pre-eclampsia
Severe intrauterine growth restriction
What are the complications of C-Section?
Bleeding
Infection
VTE
Mortality
What C-section incisions can be made?
Abdominal incision
- Pfannesteil or Vertical
Uterine incision
- Classical or LSCS
