Operative Vaginal Delivery, Breech Delivery Flashcards
What are the indictions for operative vaginal delivery?
Prolonged 2nd stage of labor
Fetal compromise
Maternal benefit
When do you consider prolonged 2nd stage of labor?
Nulliparous: lack of progress > 3 hours with RA, > 2 hours without RA
Multiparous: lack of progress > 2 hours with RA, > 1 hour without RA
What to do if forceps delivery is unsatisfactory?
If forceps cannot be applied, stop -> vacuum or CS
If forceps applied, but no descent -> stop -> CS
What are the indications for outlet forceps delivery?
Scalp is visible at the introitus Head is on the perineum Skull is at the pelvic floor Sagittal suture is in AP diameter or ROA/LOA, ROP/LOP Rotation maximum of 45 degrees
What are the cardinal movements in breech delivery?
Engagement Descent Internal rotation Lateral flexion External rotation Internal rotation Expulsion
Nuchal arms may be reduced by what maneuver?
Lovset maneuver
How do you deliver the aftercoming head in breech delivery?
Mauriceau-Smellie-Veit maneuver
Piper forceps
This refers to the incision on the cervix at the 2 o’clock and 10 o’clock position?
Duhrssen insicions
What are the top three most common causes of regional anesthesia morbidity and mortality?
High spinal or epidural blocks
Respiratory failure
Drug reaction
What agent can be used for spinal anesthesia for CS?
Bupivacaine
What are the complications of regional anesthesia?
Hypotension Fever Headache Transient fetal heart decelerations Pruritus Inadequate analgesia
When does the uterus completely involute back to pre-pregnancy size?
Approximately 10 weeks
Types of lochia
Lochia rubra: first few days, bloody
Lochia serosa: 3-4 days, pale discharge
Lochia alba: 10 days, (+) leukocytes, reduced fluids
What are the causes of uterine subinvolution?
Placental fragments
Metritis: Chlamydia trachomatis
Trophoblast and uterine interaction
What do you consider late PPH / secondary PPH?
24 hours to 12 weeks after delivery
