Operative vaginal delivery Flashcards
Indications for operative vaginal delivery?
NOT absolute! But fetal head has to be engaged and the cervix has to be fully dilated
Prolonged second stage: in nullip, means lack of continued progress for 3h with epidural or 2h without; in multip, means lack of continued progress for 2h with epidural or 1h without
or
Suspicion of immediate or potential fetal compromise
What conditions have to be met in order for a patient to be considered a candidate for operative delivery?
- Fetal head at least 2 cm below ischial spine without suspicion of cephalopelvic disproportion
- Position of head: anteroposterior, R or L OA, or posterior
- If vacuum: GA has to be at least 34w
Risks associated with vacuum delivery?
Cephalohematomas (bleed below the periosteum of the skull bones) and subgaleal hematomas (bleed between the galea/epicranial aponeurosis below the skin - associated with severe infant morbidity)
Also: intracranial hemorrhage, hyperbilirubinemia, retinal hemorrhage
Risks of forceps delivery?
Corneal abrasions, external ocular trauma, facial bruising, maternal pelvic floor trauma
Incidence of serious complications with operative delivery?
Around 5%
A 21-year-old primiparous woman at term has had an uncomplicated labor. She achieved complete dilation 3 hours ago. She has been pushing with contractions since then and the fetal head has descended to 3 cm below the maternal ischial spines with some caput. The presenting position is left occiput anterior. The fetal heart rate tracing is Category I. Estimated fetal weight is 3,800 g. Her epidural analgesia is functioning well. The patient reports that she is completely exhausted and requests an operative vaginal delivery. In counseling this patient for operative vaginal delivery by vacuum, you should inform her that the most serious complication related to use of this procedure is:
(A) subgaleal hemorrhage
(B) cephalohematoma
(C) facial palsy
(D) skull fracture
(A) subgaleal hemorrhage
