OPERATIVE INTERVENTIONS IN LABOUR

Question 1

What are the indications for an episiotomy?

Answer 1

Female circumcision

Previous perineal reconstructive surgery

Instrumental delivery

Breech delivery

Shoulder dystocia

Abnormal CTG

Question 2

What is the commonly used type of episiotomy in the UK?

Answer 2

Mediolateral

Question 3

How many layers should be individually sutured post-episiotomy?

Answer 3

Three

1. Vaginal skin
2. Perineal body
3. Perineal skin

Question 4

Having sutured up an episiotomy what must you do?

Answer 4

Perform a vaginal examination and PR examination to check that no sutures have broached rectal mucosa as this can result in fistula.

Question 5

What are the different degrees of perineal trauma?

Answer 5

1st degree: involves skin only

2nd degree: involves skin and perineal muscles only

3rd degree (a): includes partial tear (less than 50%) of external sphincter

3rd degree (b): includes partial tear (more than 50%) of external sphincter

3rd degree (c): includes internal sphincter

4th degree: involves rectal mucosa

Question 6

What is the most commonly used type of ventouse tool for assisted vaginal delivery?

Answer 6

KIWI cup

Question 7

What are the indications for using a ventouse cup?

Answer 7

Maternal: delay in 2nd stage of labour due to maternal exhaustion

Fetal: abnormal CTG or slow progress in 2nd stage of due to fetal malposition

Question 8

What are the criteria you must check are fulfilled before proceeding with any instrument assisted vaginal delivery (ventouse or forceps)?

Answer 8

Give adequate analgesia

Abdominal examination must show head is either 0/5 or 1/5 palpable, also need to estimate fetal size

Vaginal examination: cervix must be fully dilated, head must be either at or below ischial spine (2+ fetal position), you must know fetal position, note the presence of caput or moulding

Adequate maternal effort and regular contractions is necessary for a ventouse delivery

Bladder must be empty for forceps delivery

Question 9

How long should ventouse assisted delivery take maximum?

Answer 9

15 mins

Question 10

What are the complications of ventouse assisted delivery?

Answer 10

Maternal: Genital tract trauma with risk of haemorrhage and/or infection

Fetal: Chignon (scalp oedema) or cephalohaematoma

Question 11

What are the types of non-rotational or traction forceps used in delivery?

Answer 11

Simpsons
Andersons
Neville-Barnes
Wrigleys

Question 12

What are the type of rotational forceps used in delivery?

Answer 12

Keillands

Question 13

What are the maternal indications for using forceps to assist delivery?

Answer 13

Medical conditions complicating labour eg cardiovascular disease
Unconscious mother ie mother is unable to keep pushing

Question 14

What are the fetal indications for using forceps to assist delivery?

Answer 14

Gestation less than 34 weeks
Face presentation
Known or suspected fetal bleeding disorder
After-coming head of a breech
At c-section

Question 15

What are the complications of forcep assisted delivery?

Answer 15

Bruising

Rarely facial nerve palsy or depression skull fracture