Operative Delivery Flashcards
What percentage of women who deliver vaginally have some perineal trauma?
85%
What percentage of women who deliver vaginally require suturing?
70%
What is a first degree perineal tear?
Injury to perineal skin only
What is a second degree perineal tear?
injury to perineun involves muscles but not anal sphincter
What is a third degree tear
Injury to perineum involving anal sphincter (internal and/or external sphincter)
What is a fourth degree tear?
Injury involing perineal muscle, both sphincters and rectal mucosa
What are risk factors for a perineal tear?
Prolonged labour
Big babies
instrumental delivery
What is an Obstetric Anal Sphincter Injury (OASI)?
Third and fourth degree tear
What is aftercare of a OASI?
Lactulose + bulking agent
Antibiotic broad spec
Analgesia
What is an episiotomy?
Surgical incision of the perineum during the second stage of labour to enlarge the vulval outlet and assist vaginal birth
How common are episiotomies in the UK?
10% of vaginal births
How do you cut an episiotoimy?
Mediolateral at 60 degree angle
Avoids any damage to the anal sphincter
What are complications of an episiotomy?
Pain
Infection
Haemorrhage
What kind of women are most at risk for operative vaginal delivery?
Nulliparous women
What are indications for operative delivery
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)
What are risks of instrumental delivery
Maternal: trauma, to sphincter
Foetal:
- Forceps: facial N palsy, skull fractures, orbital injury, IC haemorrhage
- Venthouse: cephalophaematoma, scalp lacerations, retinal haemorrhage
What gestation is venthouse ABSOLUTELY CONTRAINDICATED for
<34 weeks
due to high risk of cephalhaematoma and IC haemorrhage
What foetal lie is ventouse ABSOLUTELLY CONTRAINSIDCATED for
Breech
Face cephalic
What are the benefits of ventouse
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)
What are benefits of forceps?
Kinder to baby
- Less cephalhaematoma and IC haemorrhage
What kind of ventouse cups exist?
Soft cups
Metal cups
What are soft cups in ventouse used for?
Uncomplicated delivery in OA
What are metal cups in ventouse used for?
OP, transverse or difficult OA
What point on the foetal head is important to determine for ventouse delivery
The flexion point (at the vertex)
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
What are four major indications for C section?
Prior C section
Malpresentation
Failure to progress in labour
Suspected foetal compromise
What kind of anaesthetic is used for CS?
SPINAL
occasionally also use epidural if surgery is expected to be prolonged
What kind of skin incisions are approprate for CS?
Pfannenstiel
Joel Cohen
Transverse
Midline laparotomy if emergency
What are the two types of uterine incision for CSec
Transverse lower segment incision
Classical CS incision
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
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
What is the Classical CS incision like
Vertical incision
Incorporates upper uterine segment
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
