Operative Delivery

Question 1

What are the two categories of operative delivery?

Answer 1

Vaginal with forceps and vacuum

C section

Question 2

When do you only perform operative vaginal delivery?

Answer 2

When there is immediate ability to do c section if it all goes to crap

Question 3

3 maternal indications for operative vaginal delivery and give an example of each?

Answer 3

Maternal exhaustion
No expulsion effort, spinal cord injury
Avoid maternal expulsion effort like in cardiac or cerebrovascular problems

Question 4

What is the one fetal indication for operative vaginal delivery?

Answer 4

Non reassuring fetal status

Question 5

What is the other indication for operative vaginal delivery?

Answer 5

Prolonged second stage of labor.
If never had a baby and its greater than 2 hours without regional or greater than 3 hours with regional
Had a baby, and its greater than 1 hour without regional or greater than 2 hours with regional

Question 6

4 criteria for mom before you can do a operative vaginal delivery?

Answer 6

Adequate analgesia, lithotomy position, bladder needs to be empty, verbal or written consent

Question 7

2 fetal criteria for operative vaginal delivery?

Answer 7

Head must be down and station must be greater than 2

Question 8

3 uteroplacental criteria for operative vaginal delivery?

Answer 8

Cervix fully dilated
Membranes ruptured
No placenta previa

Question 9

2 “other” criteria for operative vaginal delivery?

Answer 9

Experienced doc and capability to perform C section

Question 10

What is the position of the head in an outlet operative vaginal delivery?

Answer 10

Reached the pelvic floor and rotation does not exceed 45

Question 11

What is the position of the head in a low operative vaginal delivery?

Answer 11

+2 or more but not on the pelvic floor.

Question 12

What vaginal operative delivery position/technique is not indicated today?

Answer 12

Mid pelvis and high forceps where the skull is above +2.

Question 13

4 maternal complications of forceps delivery?

Answer 13

Vaginal laceration
Urethral/bladder injury
Uterine rupture
Hematomas

Question 14

5 fetal complications because of forceps?

Answer 14

Lacerations, fractures, intracranial hemorrhaging, seizures, and brachial plexus injuries

Question 15

What are the indications and requirements for vacuum assisted vaginal delivery? What is a big time advantage to using vacuum assist?

Answer 15

Same as forceps

Less maternal analgesia

Question 16

4 contraindications to vacuum assist?

Answer 16

Gestation less than 34 weeks
Baby has coagulation problem
Big baby
Breach presentation

Question 17

What is correct placement for the suction cup?

Answer 17

Posterior fontanelle

Question 18

Big time clinical pearl for using forceps and suction?

Answer 18

Make sure no maternal tissue is stuck in the forceps or cup

Question 19

How many “pop offs” are allowed with suction and what is the max time limit of suction?

Answer 19

2 pop offs

20 minutes

Question 20

4 good and bad differences of suction vs. forceps?

Answer 20

More failed deliveries with vacuum
Fewer perineal injuries to mom
More head hematoma to baby
More scalp lesions and bruising

Question 21

6 fetal indications for C section?

Answer 21

HR sucks, breech presentations, low birth weight, active HSV, immune thrombocytopenia purpura, congenital anomalies

Question 22

4 maternal-fetal indications for c section?

Answer 22

Baby ain’t fitting through mom, failure to progress labor, placental abruption and placenta previa

Question 23

C section intra operative complications? 6 of them.

Answer 23

Uterine artery injury, bladder injury, urethral injury, GI tract injury, uterus loses tone, placenta accreta

Question 24

4 post operative complications we are worried about?

Answer 24

Infection, urinary complications, GI complications and thromboembolic complications.

Question 25

5 maternal indications for c section?

Answer 25

Tumors, condyloma, cervical cerclage, vaginal colporrhaphy, conjoined twins