Tuesday, 2-28-Operative delivery (Wootton) Flashcards
options for vaginal operative delivery?
forceps-assisted and vacuum-extract
maternal indications for operative vag delivery?
- maternal exhaustion/lack of expulsive effort
- inability to have expulsive effort –> SC injuries, NM disorders
- need to avoid maternal expulsive efforts –> cardiac conditions (i.e., aortic stenosis) and cerebrovascular disease
fetal indications for operative vag delivery?
non-reassuring fetal status (bradycardia, repetitive heart rate decelerations)
fetal criteria/pre-reqs for operative vag delivery?
- vertex presentations
- fetal head must be engaged (biparietal diameter at 0 station)
- position of fetal head must be known WITH CERTAINTY
- station of fetal head must be > +2
this forceps operative vag delivery method is when the leading point of fetal head is at +2 station or more and is not on the pelvic floor (can be rotational or non-rotational)
Low
this forceps operative vag delivery is when the fetal skull is above +2 station, not ever indicated today
midpelvis and high forceps
Best position for baby head during station? Ok position?
best–> occipito-anterior (preferably straight)
ok –> occipito-posterior
when do you NOT apply forceps delivery?
- If you aren’t positive of position
- if they don’t articulate easily you re-apply but if they still don’t articulate well –> Don’t apply
maternal complications of forceps delivery?
- laceration of vagina/cervix
- episiostomy extension
- pelvic hematomas
- urethral and bladder injuries
- uterine rupture
fetal complications of forceps delivery?
- minor facial lacerations
- forceps marks
- facial and brachial plexus injuries
- cephalohematomas
- skull fractures
- intracranial hemorrhage
- seizures
indications for vacuum-assisted bag delivery? advantage of vacuum-assisted?
- EXACTLY THE SAME AS FORCEPS
- advantage: Delivery can be achieved with little maternal analgesia
contraindications to vacuum assisted vag delivery?
- gestational age < 34 wks
- suspected fetal coag disorder
- suspected fetal macrosomia
- breech presentation
correct cup placement and position for vacuum-assisted vag delivery?
Flexing median
posterior fontanelle
what 3 checks should be undertaken before use of vacuum-extraction?
- no maternal tissue trapped in cup
- cup should be placed in midline of saggital suture
- vacuum port of suction cup should point toward occiput
vacuum extractor complications?
compared to forceps:
- more failed deliveries with vacuums (failure rate of 12% for vacuum vs 7% for forceps)
- fewer perineal injuries
- increased incidence of fetal cephalohematoma
- more scalp lacerations and bruising
