Procedure: normal, complex and operative deliveries Flashcards
What are the advantages of vaginal delivery?
- shorter hospital stays
- less likely readmission
- less pain after birth
- recover more quickly from labour and birth
- better chance of starting to breastfeed their babies straight away
- are less likely to have medical problems in future pregnancies
- more physically able to care for baby and children soon after birth
- more likely to cuddle their babies and have skin-to-skin contact straight after birth
What are the disadvantages of vaginal delivery?
- may need for stitches if perineal tears occur or episiotomy is done
- may need forceps or vacuum assistance
- increased chance of incontinence or prolapse.
Which abdominal incision is used for C-section?
Either a Pfannenstiel or Joel-Cohen – both transverse lower abdominal skin incisions.
What are the layers dissected during C-section?(7)
- The skin,
- Camper’s fascia (superficial fatty layer of subcutaneous tissue)
- Scarpa’s fascia, (deep membranous layer of subcutaneous tissue)
- Rectus sheath, (anterior and posterior leaves laterally, that merge medially)
- Rectus muscle,
- Abdominal peritoneum (parietal)
- The gravid uterus.
What is the only muscle in the body that ‘wants to’ stay contracted with stimulation?
Uterus
Why is there often a lot of bleeding during C section?
Uterus receives a quarter of the blood supply in a pregnant woman
Why have rates of C-section increased significantly in recent years?
The rate of caesarean section has increased significantly in recent years, largely secondary to an increased fear of litigation
What are the two main types of caesarean section?
- lower segment caesarean section: now comprises 99% of cases
- classic caesarean section: longitudinal incision in the upper segment of the uterus
What are the indications for caesarean section?
Antenatal:
- Maternal:
- absolute cephalopelvic disproportion
- pre-eclampsia
- vaginal infection e.g. active herpes
- cervical cancer (disseminates cancer cells)
- Fetal:
- post-maturity
- IUGR
- Placental:
- placenta praevia grades 3/4
Intrapartum:
- Maternal:
- failure of labour to progress
- Fetal:
- umbilical cord prolapse
- fetal distress in labour
- malpresentations: brow
- Placental:
- placental abruption: only if fetal distress; if dead deliver vaginally
How are C-sections categorised?
Based on urgency from category 1-4 (1 being the most urgent and 4 being elective)
What are the categories of C-section?
Category 1 = an immediate threat to the life of the mother or baby –> delivery within 30 mins of making the decision
Category 2 = maternal or fetal compromise which is not immediately life-threatening –> delivery within 75 minutes of making the decision
Category 3 = delivery is required, but mother and baby are stable
Category 4 = elective caesarean
Give 4 examples of situations which may require category 1 caesarean section.
- suspected uterine rupture
- major placental abruption
- cord prolapse
- fetal hypoxia
- persistent fetal bradycardia
How does RCOG advise clinicians to make patients aware of risks/complications of C section?
By mentioning the ‘serious’ and the ‘frequent’
Give 5 examples of ‘frequent’ complications of C-section to the mother/baby.
Immediate:
- Fetal: lacerations, one to two babies in every 100
- haemorrhage
Short-term:
- readmission to hospital
- haemorrhage
- infection (wound, endometritis, UTI)
Long-term:
- discomfort in the first few months after surgery
- reduced success with subsequent VBACs
Give 5 examples of serious complications of C-section.
Immediate:
- emergency hysterectomy
- bladder injury
- ureteric injury
- death (1 in 12,000)
Short-term:
- admission to intensive care unit
- thromboembolic disease
- need for further surgery at a later date, including curettage (retained placental tissue)
- prolonged ileus
Long-term:
- future pregnancies:
- incrased risk of uterine rupture
- increased risk of antepartum stillbirth
- increased risk of placenta praevia and placenta accreta
- subfertility: due to postoperative adhesions
= Others not mentioned by RCOG.
What are the indications for instrumental vaginal delivery?
Maternal:
- failure to progress in the second stage of labour (if 1-2hrs of pushing has failed or mother exhausted)
- prophylactically in some medical conditions e.g. severe cardiac or hypertension to prevent pushing
Fetal:
- fetal distress in the second stage of labour
- breech delivery
What is meant by ventouse delivery?
Ventouse = vacuum cap connected to handle, fixed to fetal occiput by suction and allows traction during maternal pushing to delivery the OA head (normal position)
What are obstetric forceps? What are the types?
Obstetric forceps = pair that fit together for use consisting of ‘blade’, shank, lock and handle. Lock prevents them from slipping apart when they fit on the fetal head.
Types:
- Non-rotational - Simpson’s, Neville-Barnes - only suitable for OA
- Rotational forceps - Keilland’s - no pelvic curve so allow malpoistioned head to be rotated by operator to the OA position before traction is applied
Define these maneouvres, used in breech vaginal delivery:
- Pinard’s maneouvre
- Loveset’s maneouvre
- Pinard’s maneouvre - used in Frank breech where legs are extended; poking popliteal fossa of baby to make them bend their knees
- Loveset’s maneouvre - rotate the baby into the transverse position and pull the anterior arm down
