OPERATIVE OBSTETRICS PART 2 Flashcards
- aka instrumental delivery or operative vaginal delivery
- an instrument is used to assist in th ebirth of the fetal head
forceps-assisted birth
categories of forceps application
outlet
low
mid
are applied when fetal skull reached the perineum, fetal scalp is visible, sagittal suture not more than 45 degrees from the midline
outlet forceps
what forceps? fetal position - occiput anterior or posteriori left or right
outlet forceps
are applied when leaing edge (presenting part) of fetal skull is at a station of 2+ or more
low forceps
- are applied when the fetal head is engaged
- station is above +2 but not higher than station 0
mid forceps
maternal indications of forceps assisted birth
- heart disease
- pulmonary edema
- infection
- exhaustion
fetal indications for forceps assisted birth
- premature placental separation
- nonreassuring fetal status
pre requisites for foeceps assisted birth
- completely dilated
- ruptured membrane
- engaged head
- empty bladder, adequate anesthesia
- no CPD
neonatal risks of forceps assisted birth
- E___
- E___
- C___ S___ or C___
- F___ L____
- T____ F___ P____
- C___ H____
ecchymosis
edema
caput succedaneum / cephalhematoma
facial lacerations
transient facial paralysis
cerebral hemorrhage
maternal risks of forceps assisted birth
- lacerations
- episiotomy to anus
- bleeding
- perineal edema
- an obstetric procedure used to facilitate the birth of the fetus by applying suction to the fetal head
- gentler alternative to forceps
vacuum assisted birth
the vacuum extractor is composed of a ___ attached to a suction bottle by tubing
soft suction cup
the suction cup is placed against the ___ and the pump is used to create a negative pressure inside the cup
fetal occiput
pre-requisites for vacuum assisted birth
- completely dilated
- ruptured membranes
- engaged head
- vertex presentation
- no CPD
in vaccum assisted, ther should be progressive descent with the first ___ pulls
two
vacuum procedure should be limited to prevent ___
cephalhematoma
the risk of cephalhematoma generally increases if the birth does not occur within ___ minutes
6
newborn risks for vacuum assisted birth
cephalhematoma
scalp lacerations
subdural hematoma
jaundice
maternal risks for vacuum assisted birth
perineal/vaginal/cervical lacerations
soft tissue hematomas
the parents need to be reassured that the caput on the baby’s head will disappear within ___ days
2-3
- the birth of the fetus through abdominal and uterine incision
- oldest surgical procedures known
cesarean birth
- to preserve the life or health of the mother and her fetus
- may be the best choice for birth when evidence exists of maternal or fetal complications
cesarean birth
initially CS made up only 5% of births, but during the late 1980s it gradually rose to about ___
25%
in 2013, the CS rate had risen to ___
32%
factors contributing the increasing US CS birth rate
- macrosomia
- advanced age
- obseity / GDM
- multifetal
- dystocia
- decline in VBACs and TOLACs
true or false - vaginal birth has a higher maternal mortality rate than CS births
false
approximatety ___ per 100,000 women die during a vaginal birth
2.1
approx. ___ per 100,000 women die after undergoing a CS birth
5.9
CS birth incidence of death - ___ per 100,000
19.2
common associations of perinatal morbidity
- infection r/t anesthesia
- blood clots
- bleeding
C/I for CS birth
- fetal death
- fetus is too immature to survive
- maternal coagulation defects
types of CS birth
- scheduled / elective
- emergency
potential risks of CS on request
- longer hosp stay
- risk of respi problem for baby
- uterine rupture
- placental implantation problems
CS birth should not be perfomed unless a ges age of ___ has ben accurately determined
39 weeks
uterine incisions
low transverse
vertical (low / classic)
made across lowest and narrowest part of the abdomen
transverse
made between navel and symphysis pubis
vertical
- does not allow for an extension of an incision if needed
- ised when time is not of the essence
- required more time to make and repair
transverse
preferred unless without complications (very large fetus or placenta previa in the lower anterior uterus)
low transverse / low segment
reasons for use of low transverse incision
- thinnest portion
- less blood loss
- moderate dissection of the bladder
- easier to repair
- less likely to rupture
- decreased chance of adherence of bowel to the incision
- VBAC is possible
disadvanatges of low transverse incision
- takes longer
- limited in size
- greater tendency to extend laterally
- incision may stretch
- quicker and is therefor preferred in cases of nonreassuring fetal status
- preterm or macrosomic baby
- obese
vertal incision
preferred for multiple gestation, abnrmal presentation, placenta previa, nonreassuring fetal status and preterm and macroomic fetuses
low vertical incision
diadvatages of low vertical
- extend downward
- more extensive dissection of bladder
- closure is more difficult
- higher risk of rupture
- subsequent births need to be CS
- method of choice for many years but is used infrequently now
- vertical incision was made into the upper uterine segment
classic incision
- more blood loss and more difficult to repair
- increased risk of uterine rupture with usbsequent pregnancy, labor and birth
classic incision
maternal complication of classic incision
- aspiration
- hemorrhage
- atelectasis
- endometritis
- abdominal wound dehiscence
- UTI
- bladder/bowel injury
fetus complications of classic incision
- asphyxia
- injuries caused by scalpel
- longer recovery
delayed ___ to rpomote eye contact between parent and infant in the 1st hour after birth
installation of eye drops
CS birth should - ___ after midnight
NPO
give preop meds - ___ may be administered within 30 mins of surgery
antacids
after CS birth mother should ___ after 12 hours
ambulate
most common complication after CS birth
pelvic thrombosis (blood clot in pelvic vein)
- the women undergoes a trial of labor in cases of nonrecurring indications for a CS
- influenced by a consumer demand that this was a viable alternative to repeat CS
VBAC - vaginal birth after cesarean
overall success rate is approx ___
60 to 80%
benefits of VBAC
- avoid major abdominal surgery
- lower rates hemorrhage, infection
- shorter recovery period
- avoid hysterectomy, bowel/bladder injury, transfusion, infection, and abnormal placentation
potential harms of VBAC
- hemorrhage
- infection
- operative injury
- thrombolembolism
- hysterectomy
- death
a failed ___ is associated with more complications than elective repeat CS delivery
TOLAC - trial of labor after cesarean
___ is higher in the setting of a failed TOLAC than in VBAC
neonatal morbidity
C/I for VBAC
- previous t-shaped incision
- previous extensive transfundal uterine surgery
- vaginal delivery is contraindicated
VBAC - generally a ___ is inserted for IV access if needed or an IVF is started
saline lock
