Operative Delivery Flashcards

1
Q

What percentage of women who deliver vaginally have some perineal trauma?

A

85%

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2
Q

What percentage of women who deliver vaginally require suturing?

A

70%

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3
Q

What is a first degree perineal tear?

A

Injury to perineal skin only

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4
Q

What is a second degree perineal tear?

A

injury to perineun involves muscles but not anal sphincter

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5
Q

What is a third degree tear

A

Injury to perineum involving anal sphincter (internal and/or external sphincter)

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6
Q

What is a fourth degree tear?

A

Injury involing perineal muscle, both sphincters and rectal mucosa

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7
Q

What are risk factors for a perineal tear?

A

Prolonged labour
Big babies
instrumental delivery

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8
Q

What is an Obstetric Anal Sphincter Injury (OASI)?

A

Third and fourth degree tear

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9
Q

What is aftercare of a OASI?

A

Lactulose + bulking agent
Antibiotic broad spec
Analgesia

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10
Q

What is an episiotomy?

A

Surgical incision of the perineum during the second stage of labour to enlarge the vulval outlet and assist vaginal birth

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11
Q

How common are episiotomies in the UK?

A

10% of vaginal births

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12
Q

How do you cut an episiotoimy?

A

Mediolateral at 60 degree angle

Avoids any damage to the anal sphincter

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13
Q

What are complications of an episiotomy?

A

Pain
Infection
Haemorrhage

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14
Q

What kind of women are most at risk for operative vaginal delivery?

A

Nulliparous women

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15
Q

What are indications for operative delivery

A

Foetal:
- foetal compromise

Maternal

  • Lack of progress in second stage (2h nullip, 1h multip)
  • Maternal exhaustion/vomiting/distress
  • Maternal indication to avoid prolonged pushing (caridac disease, HTN crisis)
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16
Q

What are risks of instrumental delivery

A

Maternal: trauma, to sphincter
Foetal:
- Forceps: facial N palsy, skull fractures, orbital injury, IC haemorrhage
- Venthouse: cephalophaematoma, scalp lacerations, retinal haemorrhage

17
Q

What gestation is venthouse ABSOLUTELY CONTRAINDICATED for

A

<34 weeks

due to high risk of cephalhaematoma and IC haemorrhage

18
Q

What foetal lie is ventouse ABSOLUTELLY CONTRAINSIDCATED for

A

Breech

Face cephalic

19
Q

What are the benefits of ventouse

A

Kinder to mother

  • Less pelvic floor trauma
  • Less anal sphincter injury
  • Less maternal regional / general anaesthetic
  • less perineal pain
  • Less lacerartions, facial palsy (TO CHILD)
20
Q

What are benefits of forceps?

A

Kinder to baby

  • Less cephalhaematoma and IC haemorrhage
21
Q

What kind of ventouse cups exist?

A

Soft cups

Metal cups

22
Q

What are soft cups in ventouse used for?

A

Uncomplicated delivery in OA

23
Q

What are metal cups in ventouse used for?

A

OP, transverse or difficult OA

24
Q

What point on the foetal head is important to determine for ventouse delivery

A

The flexion point (at the vertex)

25
What types of forceps can you use?
Non rotational, when head is OA with <45 degree rotation Rotational forceps, when head is >45 degrees from vertical. Accomplish rotation before traction
26
What are four major indications for C section?
Prior C section Malpresentation Failure to progress in labour Suspected foetal compromise
27
What kind of anaesthetic is used for CS?
SPINAL | occasionally also use epidural if surgery is expected to be prolonged
28
What kind of skin incisions are approprate for CS?
Pfannenstiel Joel Cohen Transverse Midline laparotomy if emergency
29
What are the two types of uterine incision for CSec
Transverse lower segment incision | Classical CS incision
30
What are benefits of Transverse lower segment incision
Repairs easier than classical incision Reduced blood loss Low risk of dehiscence or rupture in subsequent pregnancies
31
What are indications for Classical CS incision
Lower uterine segment with fibroids Lower segment covered in dense adhesions Placenta previa Foetal abnormality (e.g. coinjoined twins) Carcinoma of cervix
32
What is the Classical CS incision like
Vertical incision | Incorporates upper uterine segment
33
What medication should you give after foetus is delivered in C sec
Oxytocin agent e.g IV syntocynon This aids uterine contractions and placental separation