Operative vaginal delivery Flashcards
What is initial management of prolonged deceleration?
Arrive in room with fHR in 70s: assess vitals, resuscitative measures (LL decubitus, fluid bolus, stop pitocin), perform cervical exam, check that OR is available.
Describe how you apply the vacuum onto the fetal head?
Place vacuum over the sagittal suture, approximately 3cm from posterior fontanelle and 6cm from anterior fontanelle. Apply downward traction.
What are contraindications for operative vaginal delivery?
- Unengaged fetal head
- unknown fetal position
- Bone disease (eg. osteogenesis imperfect)
- Fetal bleeding disorder (AIT, vWD, hemophilia)
- vacuum < 34wks
- provider inexperience
- pt refusal
- incomplete cervical dilation, lack of proximity to OR
- maternal HIV/hepB
Describe how you would apply forceps to the fetal head?
Elliot and Simpsons.
How long would you do vacuum or forceps for?
If there was no descent of the fetal head. 3 pop-offs for vacuum.
If fetus not delivered in reasonable time (~15-20 min or after 3 pulls).
Do not do sequential use of operative delivery methods. It can increase morbidity
What are indications for operative vaginal delivery?
Maternal:
- exhaustion, inability to push effectively, cardiac disease/need to avoid pushing in second stage, prolonged second stage, arrest of descent
Fetal:
- NRFHR in second stage
Assess EFW, adequacy of pelvis and anesthesia, fetal station/position, adequate
What are the different types of forceps?
Outlet: head visible at introits or on perineum.
Low: head at +2 station or below
Mid: head above +2 station (but engagement has occurred)
What are maternal complications of OVD?
anal sphincter tears (more w/ forceps)
What are neonatal complications of OVD?
Rare (<0.3%), similar to CD
VACUUM: laceration, cephalohematoma (accumulation of blood under scalp), subgaleal (under scalp but can cross suture lines), and ICH, retinal hemorrhage, hyperbilirubinemia.
FORCEPS:
- facial laceration, facial nerve palsy, corneal damage, skull fracture, ICH
