OPERATIVE OBSTETRICS PART 1 Flashcards
A number of special procedures which the physician may use to assist the mother in labor & delivery
operative obstetrics
- Turning the fetus, is a procedure used to change the fetal
presentation by abdominal or intrauterine manipulation.
version
2 types of version
external / external cephalic version
internal podalic version
- the presentation of the fetus is changed from a breech, shoulder,
or oblique to a cephalic presentation by external manipulation of
the maternal abdomen
ECV
criteria for ECV
- atleast 37 weeks
- reactive nonstress test
- fetal breech not engaged
___ is used to locate the placenta and to confirm fetal presentation and gestational age and determine the adequacy of amniotic fluid
UTZ
A ___ agent may be administered to help relax uterus
tocolytic
risks for ECV
- FHR changes
- entangle or compress cord
- abruptio placenta
- mixing of fetal and maternal blood
*Used only w/ the 2
nd twin during a vaginal birth
and only if the twin does not descend readily or if
the heart rate is non-reassuring
internal podalic version
OB places a hand into the uterus, and with the other hand on the maternal abdomen, maneuver
the fetus into a longitudinal lie (cephalic or breech)
to allow delivery
internal podalic version
*an artificial rupture of the amniotic
membranes (AROM)
*Most common operative procedure
amniotomy
amniotomy - Instrument is inserted through the cervix at least ___ of cervical dilatation
3 cm
risks of amniotomy
- cord prolapse
- infection
- abruptio placenta
instrument used for amniotomy
amniohook
in which case is amniotomy deferred?
presenting part is high in the pelvis OR presenting part not cephalic
amniotomy - temp is monitored every ___
2 hours
After birth, if meconium is present = ??
baby’s vocal cord is visualized and deep suctioning is done
If labor is not established within 2 to 4 hours after AROM, ___ may be administered as ordered
oxytocin
*refers to softening and effacing of the cervix
*may be used for the pregnant woman at or near term when there is a medical or obstetric indication for induction of labor
cervical ripening
simplest method of cervical ripening
stripping the membrane
- A nonpharmacologic method of
induction frequently used by
physicians/CNMs (or sweeping the
amniotic membranes) - The practitioner inserts a gloved
finger into the internal os and
rotates it 360 degrees twice,
separating the amniotic membranes that are lying against the lower uterine segment.
stripping the membranes
stripping the membranes releases ___ to stimulate ___
prostaglandins; uterine contractions
suppositories of seaweed that swell on contact with cervical secretions which gradually and gently urge dilatation.
hygroscopic suppositories
pharmacologic methods of cervical ripening
prostaglandin agents
misoprostol
- shorten labor, and to lower requirements for Pitocin
during labor induction
prostaglandin agents
is used in a hospital birthing unit, and it is recommended that an obstetrician be available in
case of emergency caesarean birth is needed
prostaglandin gel
major adverse reaction of prostaglandin
tachysystole
administered in a setting in which fetal monitoring and emergency
care, including immediate caesarean birth are readily available
prostaglandin agents
is a synthetic PGE1 analogue that some healthcare agencies use to ripen the cervix and induce labor
misprostol
- available as a tablet that is inserted vaginally
misprostol
cytotec - Use only during the ___ trimester for cervical ripening or labor induction
3rd
initial dose of cytotec
1/4 tablet or 25 mcg
misoprostol - * Recurrent administration should not exceed dosing intervals of ___
less than 3-6 hours
- ___ should be administered at least 4 hours after the last Cytotec
dose
pitocin
cytotec C/I
- 3x contractions in 10 mins
- asthma
- previous c/s birth
- bleeding
- placenta previa
- non-reassuring fetal heart rate
Is taken to prevent stomach ulcers in patients taking
anti-inflammatory drugs, including aspirin
off label use for cervical ripening
misoprostol
- balloon-tipped foley catheter in the cervix with possible saline infusion through the catheter into the space between the internal os and intact membranes
Transcervical catheter
another method mechanical ripening of cervix is Placement of ___ into the cervical canal
hydrophillic inserts
position recommended for usually one our after using cervical ripener
supine with a right hip wedge
Monitor the woman for uterine ____ and ___ for at least 2 hours following insertion
hyperstimulation and FHR abnormalities
If ___ are present or contractions occur more frequently than every ___, the gel is removed.
nausea and vomiting
2 minutes
*Use of artificial methods to stimulate uterine contractions before the spontaneous onset of labor, with or without ruptured fetal membranes, for the purpose of accomplishing birth
induction of labor
induction of labor indications
- 39 wks
- ges/chronic HTN
- preeclampsia
- eclampsia
- DM
- PROM
- IUFD
- IUGR
- post term
induction of labor C/I
- transverse position
- cord prolapse
- active genital herpes
- placenta previa
- previous myomectomy
pre-requisites of induction of labor
- fetus in longitudianal lie
- ripe cervix
- engaged presenting part
- no CPD
- fetal maturity
*A primary line of 1L of electrolyte solution (e.g. Lactated Ringer’s solution) is started IV.
* 10 “u” of Oxytocin (Pitocin) are added to secondary line of 1L IVF (D5LR); the mixture will contain 10 mU of oxy/ml (1mU/min=6ml/hr)
pitocin infusion
After the primary infusion is started, the Pitocin solution is ___ into the primary tubing port closest to the catheter insertion
piggybacked
- The goal for induction is to achieve stable contractions every ___ that last ___
2-3 minutes
40-60 seconds
The uterus should relax to ____ between each contraction.
full baseline resting tone
natural, non-invasive complementary methods of induction of labor
nipple stimulation
exercise
sex
homeopathy and herbs
castor oil
If ____, then drugs or mechanical cervical
dilators should be used to ripen the cervix before labor is induced.
cervix is not sufficiently dilated
Inducing labor with misoprostol should be avoided in women who have had even one prior cesarean delivery due to the possibility of ___.
uterine rupture
A ____ should be readily
available any time induction is used in the event that induction is not successful.
physician capable of performing CS
- a technique by which
warmed, sterile normal
saline or Ringer’s lactate
solution is introduced
into the uterus through
an intrauterine pressure
catheter (IUPC)
amnioinfusion
uses of amnioinfusion
- increase volume during oligohydramnios
- extra cushion to relieve pressure on cord
- to dilute moderate to heavy meconium
- indicated for PTL with PROM
- w/ suspected cord compression, the immediate intervention is to
___
assist to another position
after positioning If not successful in restoring the FHR, an ____ may be considered.
amnioinfusion
A surgical incision of
the perineal body to
enlarge the outlet.
The second most
common procedure
in maternal-child
care.
episiotomy
is made with blunt-tipped scissors
in the midline of the perineum or is
begun in the midline but directed laterally away from the rectum
episiotomy
advantages of episiotomy
- substitute a clean cut for a ragged tear
- minimize pressure on fetal head
- shorten the second stage of labor
preventive measures for episiotomy
- kegels
- perineal masssage
- natural pushing, avoiding lithotomy
- side-lying position
- warm / hot compress on perineum
- gradual expulsion
types of episiotomy
median/midline
mediolateral
At the time of an episiotomy incision, there is a slight loss of blood, but ___ immediately seals the cut edges and minimizes bleeding.
pressure of presenting part
*midline of the perineum
*minimal blood loss
*neat healing w/ little
scarring
median
- result in less postpartal
discomfort - added laceration may
extend into the anal sphincter - limited enlargement of the vaginal opening because perineal length is
limited
median
- is begun in the midline but directed
laterally away from the rectum - more enlargement of the vaginal opening
mediolateral
- little risk that it will extend into the anus
- more blood loss
- increased postpartum pain
mediolateral
- more scarring and irregularity in the healed scar
- prolonged dyspareunia
mediolateral
episiotomy - Apply an ice pack to the perineum for ___ and removed for at least 30 minutes before being reapplied.
20-30 minutes
Episiotomy site should be inspected every ___ during the first
hour after birth for redness, swelling, tenderness, bruising, and
hematomas.
15 minutes
