Week 2 Operative Birth Flashcards
What is operative vaginal birth?
Application of traction to or assist descent of or rotation of the fetal head during birth to aid in the woman’s expulsive efforts
What is the function of the vacuum extractor?
uses Suction to grasp the fetal head while traction is applied
What are the contraindications for vacuum extraction?
- Breech, face, or brow presentation
- CPD
- Unengaged fetal head
- Incompletely dilated cervix
- Bleeding disorder
- < 34 wgs (risk head/intracranial trauma)
How many popoffs until vacuum extraction is no longer indicated?
3
If you reach your popoff limit delivery using ___ is also contraindicated
Forceps
What are the maternal indications for operative vaginal birth
- Exhaustion
- Inability to push effectively
- Infection
- Cardiac or pulmonary disease
What are the fetal indications for operative vaginal birth
- Failure of the fetal presenting part to fully rotate and descend in the pelvis
- Partial separation of the placenta
- Abnormal FHR patterns near the time of birth
When is operative vaginal birth considered?
Considered if the second stage should be shortened for well-being of mother and/or baby AND if vaginal birth can be accomplished without undue trauma
What are the maternal risks of operative vaginal birth
- Laceration
- Hematoma of vagina,
- pelvic floor disorders,
- anal sphincter disruption
- infection
What are the Fetal risks of operative vaginal birth
- Ecchymoses
- Facial and scalp lac and abrasions
- Facial nerve injury
- Cephalohematoma
- Intracranial hemorrhage: Subgaleal hemorrhage most often associated with vacuum extraction and forceps delivery d/t inappropriate placement
What is a very important additional newborn assessment to be done after operative vaginal birth?
Neuromuscular
How do you tell the difference between a Caput Succadaneum and a cephalhematoma?
The caput crosses sutures the Cephalhematoma does not
What monitoring do you do after operative vaginal birth
- Monitor for 8 hours min
- Close VS monitoring for signs of hypovoilumemic shock
- Hourly HC
- Presence of fluctuance
- Monitor H/H and coag q 4-8
- Seizures
- CT or MRI
What are the three classifications of operative vaginal birth?
- Outlet
- Low
- Mid-pelvis
What is an outlet operative vaginal birth?
the fetal head is at or on the perineum with the scalp visible at the vaginal opening without separating the labia. The position is either ROA or LOA or ROP/LOP
What is a low operative vaginal birth?
the leading edge of the fetal skull is at station +2 cm or lower and NOT on the pelvic floor. Subdivided according to the amount of rotation of the fetal head needed. Rotation of 45 degrees or less are simpler
What is a mid-pelvis operative vaginal birth?
Mid-pelvis: leading edge of the fetal skull is between 0 and +2 cm
During a operative vaginal birth, a _____ may be performed to allow easier passage
Episiotomy
If forcep or vacuum extraction is anticipated ____ should be added to the instrument table
Urinary catheter
Why is a urinary catheter needed at a forcep or vacuum extraction
To allow bladder to be emptied
During vacuum extraction, a FHR lower than ___ must be reported
100 bpm
after a forcep or vacuum extraction delivery, you should immediately assess for ___
trauma
If after a forcep or vacuum extraction the mother has a laceration or hematoma, ____is applied for 12 hours
ice
After a forcep or vacuum extraction delivery, the newborn should be assessed for ___
skin breakdown, bruising, facial asymmetry for facial nerve injury), caput or cephalohematoma common at vacuum extractor cup location
What are the risks to the baby in a c-section?
- Inadvertent preterm birth
- TTN
- Persistent pulmonary htn
- Injury (lac, bruising, fx, or other trauma)
What are the two types of cutaneous incisions used in a C-section?
Vertical and Pfannenstiel
What are the three uterine incisions used in a c-section?
- Low transverse
- Low vertical
- Classic
What are the advantages to a vertical cutaneous C-section incision?
- Quick
- Better visualization
- Can be extended faster
- Better for obese women
What are the advantages to a Pfannenstiel cutaneous C-section incision?
- Less visible
- Less chance of dehiscence or hernia
What are the disadvantages to a vertical cutaneous C-section incision?
- Very visable
- Greater chance of dehiscence or hernia
What are the disadvantages to a Pfannenstiel cutaneous C-section incision?
- Less visualization of uterus
- Not quick
- Cant be easily extended
- Reentry takes longer
what are the advantages of a low transverse uterine incision for a c-section?
- unlikely to rupture
- VBAC possible
- Less blood loss
- Easy to repair
- less adhesions
what are the advantages of a low vertical uterine incision for a c-section?
-can be extended
what are the advantages of a classic uterine incision for a c-section?
- Used in emergencys
- used if dense adhesions are present
- used if infant is transverse lie with impacted shoulder
what are the disadvantages of a low transverse uterine incision for a c-section?
-limited ability to extend
what are the disadvantages of a low vertical uterine incision for a c-section?
- More likely to rupture
- If it tears it may extend to cervix
what are the disadvantages of a classic uterine incision for a c-section?
- Most likely to rupture with subsequent preg.
- Eliminates VBAC
What is TOLAC?
trial of labor after cesarean delivery
What is TTN?
Transient Tachypnea of Newborn
