OPERATIVE VAGINAL DELIVERY Flashcards
What is operative vaginal delivery (OVD)?
Birth accomplished with assistance from forceps or a vacuum-cup device, using outward traction to augment maternal pushing.
What is the ratio of vacuum to forceps deliveries?
Approximately 4:1.
What are the common maternal indications for OVD?
-Maternal exhaustion
- prolonged second-stage labor
- pulmonary compromise
-infection-related decompensation
- neurological disease
- cardiac disorders.
What are frequent fetal indications for OVD?
- Nonreassuring fetal heart rate
- premature placental separation.
What are the three classifications of OVD based on station?
Outlet, low, and midpelvic.
(mc are outlet and low)
What is the prerequisite for fetal station in low forceps delivery?
Fetal station must be ≥+2 cm but not on the pelvic floor.
What type of regional analgesia is preferred for low or midpelvic OVD?
Regional analgesia is preferred; pudendal blockade may suffice for outlet deliveries.
Why should the maternal bladder be emptied before OVD?
To provide additional pelvic space and minimize bladder trauma.
What is OASIS in the context of OVD complications?
Obstetrical anal sphincter injuries, including third- and fourth-degree perineal lacerations.
Which episiotomy type offers greater protection against OASIS?
Mediolateral episiotomy.
What are common neonatal injuries associated with vacuum extraction during OVD?
- Cephalohematoma
- subgaleal hemorrhage
- retinal hemorrhage
- neonatal jaundice
- scalp lacerations.
What types of injuries are more frequent with forceps delivery?
- Facial nerve injury
- brachial plexus injury
- depressed skull fracture
- corneal abrasion.
What is a proposed mechanism for brachial plexus injury during OVD?
Traction forces causing stretch on the brachial plexus as the fetal head descends while the shoulders remain at the pelvic inlet.
Is long-term neurodevelopmental morbidity associated with OVD?
No, studies show no significant association between OVD and long-term neurodevelopmental issues like epilepsy or cerebral palsy.
When is a trial of OVD recommended?
When the procedure is expected to be difficult, to allow immediate cesarean delivery if it fails.
What are the four components of a forceps branch?
Blade, shank, lock, and handle.
(BS-LH)
BLADE
SHANK
LOCK
HANDLE
What does the cephalic curve of the forceps blade conform to?
The round fetal head.
What is the function of the pelvic curve in forceps design?
It corresponds to the curve of the birth canal.
What is the advantage of fenestrated blades in forceps?
They reduce head slippage during forceps rotation.
What is the disadvantage of fenestrated blades?
Increased blade thickness and friction against the vaginal wall.
What are pseudo-fenestrated forceps blades?
Blades smooth on the outer maternal side but indented on the inner fetal side.
What is the purpose of parallel shanks in forceps?
They limit compression of blades against the fetal head.
What is a disadvantage of parallel shanks?
They add width against the introitus.
What is the benefit of overlapping shanks in forceps?
They raise compression forces but distend the perineum less, making them advantageous for outlet deliveries.
What are the three main types of forceps locks?
(SEP)
SLIDING LOCK
ENGLISH LOCK
PIVOT LOCK