Operative Delivery (6)

Question 1

Operative deliver means?

Answer 1

Anything not normal..
Vaginal: forceps assisted, vacuum extracted
Cesarean deliver

Question 2

What are some maternal indications for operative deliver? Fetal?

Answer 2

Maternal exhaustion
SC injury or neuromuscular disorder
Cardiac conditions (aortic stenosis)
Cerebrovascular dx (aneurysm, brain tumor)

Poor fetal status

Question 3

Maternal criteria for operative vaginal delivery? Fetal?

Answer 3

Adequate analgesia (epidural block)
Lithotomy position (on back w/ legs up and out)
Empty bladder
Consent
Cervix fully dilated
Membranes ruptured
Capability to perform an emergency c-section

Position of head must be certain
Station of fetal head must be > +2

Question 4

Which directions are best for delivering a baby? Worst?

Answer 4

Right OA, straight OA, left OA
Right OP, straight OP, left OP

Right OT, left OT

Question 5

If you aren’t confident about a baby’s position, should you put the forceps on?

Answer 5

HELL NO

Question 6

Which means of operative deliver, vacuum or forceps, can be done w/ less maternal analgesia?

Answer 6

Vacuum

Question 7

When can you not vacuum?

Answer 7

Gestational age < 34 weeks
Suspected coagulation disorder
Macrosomia

Question 8

What’s the correct placement of a vacuum?

Answer 8

Posterior fontanelle

Question 9

What’s the time limit on vacuum application?

Answer 9

20 minutes

Question 10

What method, vacuum or forceps, leads to more failed deliveries?

Answer 10

Vacuum (12%) vs forceps (7%)

• inc risk of cephalohematomas
• more scalp trauma

Question 11

What’s a great reason to have a c-section?

Answer 11

Active HSV infection

Question 12

What’s a dehiscence?

Answer 12

A previously closed wound that re-opens