Operative Delivery

Question 1

2 categories of operative delivery

Answer 1

Vaginal: forceps assisted, vacuum extracted

Cesarean delivery

Question 2

T/F: operative vaginal delivery involves direct traction to the fetal skull, and should only be performed when there is immediate ability to do a cesarean section

Answer 2

True

Question 3

Maternal indications for operative vaginal delivery

Answer 3

Maternal exhaustion/lack of expulsive effort

Inability to have expulsive effort (spinal cord injuries, neuromuscular disorders)

Need to avoid maternal expulsive efforts (aortic stenosis, aneurysm, brain tumor, etc.)

Prolonged second stage of labor

Question 4

Fetal indications for operative vaginal delivery

Answer 4

Non-reassuring fetal status (i.e., bradycardia, repetitive heart rate decelerations)

Question 5

Maternal criteria necessary to perform operative vaginal delivery

Answer 5

Adequate analgesia
Lithotomy position
Bladder empty
Verbal or written consent

Ureteroplacental criteria: cervix fully dilated, membranes ruptured, no placenta previa

Question 6

Fetal criteria necessary to perform operative vaginal delivery

Answer 6

Vertex presentation

Fetal head must be engaged (biparietal diameter at 0 station)

Position of fetal head must be known with certainty

Station of the fetal head must be >+2

Question 7

Maternal complications from forceps delivery

Answer 7

Laceration of vagina/cervix

Episiotomy extension

Pelvic hematomas

Urethral and bladder injuries

Uterine rupture

Question 8

Fetal complications from forceps delivery

Answer 8

Minor facial lacerations

Forceps marks

Facial and brachial plexus injuries

Skull fractures

Intracranial hemorrhage

Seizures

Question 9

The indications and requirements for vacuum-assisted vaginal delivery are the same as for forceps delivery. What is the advantage of vacuum-assisted as opposed to forceps?

Answer 9

With vacuum assisted, delivery can be achieved with little maternal analgesia

Question 10

Contraindications to vacuum assisted vaginal delivery

Answer 10

Gestational age <34 wks

Suspected fetal coagulation disorder

Suspected fetal macrosomia

Breech presentation

Question 11

When comparing vacuum-delivery to forceps delivery — which one is associated with more failed deliveries, fewer perineal injuries, increased incidence of fetal cephalohematoma, and more scalp lacerations and bruising?

Answer 11

Vacuum-delivery

Question 12

Fetal indications for C-section

Answer 12

Non-reassuring fetal heart rate

Breech presentation/transverse position

Very low birth weight (<1500g)

Active HSV infection

Immune thrombocytopenic purpura

Congenital anomalies (i.e., gastroschisis, spina bifida)

Question 13

Maternal-fetal indications for C-section

Answer 13

Cephalopelvic disproportion

Failure to progress

Placental abruption

Placenta previa (other placental position abnormalities like vasa previa)

Obstructive benign and malignant tumors

Large vulvar condyloma

Abdominal cervical cerclage

Prior vaginal colporrhaphy

Conjoined twins

Maternal request

Question 14

C-section intraoperative complications

Answer 14

Uterine artery lacerations

Bladder and/or ureteral injuries

GI tract injury

Uterine atony

Placenta accreta

Cesarean hysterectomy

Question 15

Postoperative complications of C-section

Answer 15

Endomyometritis

Wound complications (infection, separation, dehiscence)

Urinary complications (retention, infection)

GI complications (Ileus, diarrhea)

Thromboembolic disorders (PE, DVT)

Septic pelvic thrombophlebitis