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Y5 Gynae & Obstetrics > Operative Delivery > Flashcards

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
Q

What types of forceps can you use?

A

Non rotational, when head is OA with <45 degree rotation

Rotational forceps, when head is >45 degrees from vertical. Accomplish rotation before traction

26
Q

What are four major indications for C section?

A

Prior C section
Malpresentation
Failure to progress in labour
Suspected foetal compromise

27
Q

What kind of anaesthetic is used for CS?

A

SPINAL

occasionally also use epidural if surgery is expected to be prolonged

28
Q

What kind of skin incisions are approprate for CS?

A

Pfannenstiel
Joel Cohen
Transverse
Midline laparotomy if emergency

29
Q

What are the two types of uterine incision for CSec

A

Transverse lower segment incision

Classical CS incision

30
Q

What are benefits of Transverse lower segment incision

A

Repairs easier than classical incision
Reduced blood loss
Low risk of dehiscence or rupture in subsequent pregnancies

31
Q

What are indications for Classical CS incision

A

Lower uterine segment with fibroids
Lower segment covered in dense adhesions
Placenta previa
Foetal abnormality (e.g. coinjoined twins)
Carcinoma of cervix

32
Q

What is the Classical CS incision like

A

Vertical incision

Incorporates upper uterine segment

33
Q

What medication should you give after foetus is delivered in C sec

A

Oxytocin agent
e.g IV syntocynon
This aids uterine contractions and placental separation

Y5 Gynae & Obstetrics (34 decks)

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