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Urogenital System > 4. Operative obstetrics > Flashcards

4. Operative obstetrics Flashcards

1
Q

When is an operative delivery performed

A

If a spontaneous birth is judged to pose a greater risk to mother or child than an assisted one

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2
Q

What are the two types of operative delivery

A

Abdominal methods

Vaginal Assisted Deliveries

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3
Q

What is one type of Abdominal operative delivery method

A

Caesarean section

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4
Q

List two types of Vaginal assisted deliveries

A

Forceps Delivery

Vacuum Extraction

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5
Q

What is the definition of caesarean section

A

Removal of a fetus from the uterus by abdominal and uterine incisions, after 24 weeks of pregnancy

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6
Q

Term used to describe Removal of a fetus from the uterus by abdominal and uterine incisions, before 24 weeks of pregnancy

A

Hysterectomy

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7
Q

C- sections account for what percentage of deliveries

A

15-25%

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8
Q

List nine indications for C-Section

A 
Cephalopelvic disproportion
Relative Cephalopelvic disproportion
Placenta Praevia
Fetal Distress
Prolapsed cord
To avoid fetal hypoxia
Malpositions
Mal presentations 
Bad obstetric history
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9
Q

What does the term Cephalopelvic disproportion allude to

A

Obvious either antenatally or in early stages of labor that the fetus, presenting by the head, is not going to pass through the pelvis

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10
Q

What is meant by the term Relative Cephalopelvic Disproportion

A

Relative CPD (also known as FPD - Feto-Pelvic Disproportion) is the supposed inability of a baby to navigate through the mother’s pelvis, perhaps due to one of the following reasons: 1. Position of the baby’s head - The baby may have his head straight or tilted back instead of flexed with chin to chest.

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11
Q

What is Placenta Previa

A

This term is used describe when the baby’s placenta completely covers the mother’s cervix

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12
Q

What is the most common fetal malposition

A

Occiput posterior (OP) position

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13
Q

What are the grounds for allowing a repeat Caesarean Section

A

Repeat depends on the use for the 1st Csection

Ex: a recurrent indication such as small pelvis

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14
Q

What are the four Categories that indications for Caesarean Section are grouped under?

A

Category one: emergency
Category two: urgent
Category three: scheduled
Category four: elective

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15
Q

What classifies a C-section as emergency or category one

A

Immediate threat to mother or fetus

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16
Q

An emergency C-section should be done within which time span

A

30 mins

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17
Q

What classifies a Csection as Urgent / Category 2

A

Maternal/ Fetal compromise but not life threatening

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18
Q

Delivery of an urgent C section should be completed within what time span

A

60-75 mins

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19
Q

What classifies a C-section as scheduled or category three

A

Mother needed early delivery but no maternal or fetal compromise

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20
Q

What classifies a C-section as Category 4 or elective?

A

Delivery timed to suit the mother and staff

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21
Q

List some factors that increase the rate of Caesarean section

A 
Inaccurate pregnancy dating
Fetal monitoring 
Macrosomia
Maternal request
Advancing maternal age
Socioeconomic factors
Reduced parity
Improved surgical techniques 
Health Insurance 
Choose the time and day of delivery 
Epidural anaesthesia
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22
Q

Which incision is used in a c section

A

Pfannenstiel’s incision

Transverse lower abdominal incision

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23
Q

Describe where the lower segment incision for c section is made

A

It is a gently curved Pfannenstiel’s incision following the Langer’s lines in the skin

Made 3cm above the pubis in the centre

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24
Q

Describe where the Classic upper segment operation incision for Caesarean section is done

A

A vertical right paramedian incision from level of umbilicus to 3cm above pubic symphysis

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25
Q

List the steps to the Caesarean Section

A 
Drain bladder with in dwelling catheter
Open abdomen
Expose lower uterine segment
Incise Visceral Peritoneum 
Push bladder down
Open uterus with a transverse incision
When bulge of membranes appears, pricked and open amniotic sac fully with a finger from each side 
Deliver baby if presentation is by the head
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26
Q

In C section
After
The bladder is drained with in dwelling catheter
Which step is next

A

Open abdomen

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27
Q

In C section
After opening the abdomen
Which step in next

A

Expose lower uterine segment

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28
Q

In c section

After exposing the uterine segment which step is next

A

Incise Visceral Peritoneum

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29
Q

In C section after you incise the visceral peritoneum, which step is next

A

Push bladder down

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30
Q

In c section after you push the bladder down, which step is next

A

Open uterus with a transverse incision

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31
Q

In C section after you open the uterus with a transverse incision
Which step is next

A

When bulge of membranes appears, pricked and open amniotic sac fully with a finger from each side
Deliver baby if presentation is by the head

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32
Q

Which drug is administered during and immediately after delivery of a baby to help the birth and to prevent or treat excessive bleeding

A

Syntometrine

33
Q

How does Syntometrine work

A

It works by stimulating the muscles of the uterus (womb) to produce rhythmic contractions

34
Q

When is a vertical uterine incision used in c section

A

If the lower segment is unapproachable because of fibroids

If Transverse fetal lie with the back inferior

If lower segment is not formed

35
Q

What are the two types of regional block administered during a Caesarean Section

A

Spinal (fastest and densest block)

Epidural (allows postoperative top ups for continuing pain relief)

36
Q

Why is general anaesthesia avoided for c section

A

incidence of complications postoperatively are higher than those of Regional blocks

37
Q

What are some complications of General Anaesthesia during c section

A

Aspiration of stomach contents
Chest infections
Thrombosis

38
Q

What are three main indications for General Anaesthesia

A

Maternal Anxiety
Operation likely to be complicated
Emergency, when insufficient time to establish epidural or spinal block

39
Q

List four complications of c section

A

Haemorrhage
Infection
Ileus
Thrombosis

40
Q

What is used to reduce risk of infection after C section

A

Prophylactic antibiotics

41
Q

How do you treat ileus after c section

A

With IV fluids and no oral fluids until after the mother has passed flatus

42
Q

The risk of a c section pt developing thrombosis is how much greater than than of a vaginal delivery pt

A

8x

43
Q

Thrombosis after c section commonly occurs where

A

Leg or Pelvic Veins

44
Q

What is used to prevent thrombosis in a c section patient (esp those older than 35, anemic, history of thrombosis, pre eclampsia, prolonged inactivity, obesity)

A

Prophylactic anticoagulant

45
Q

List three types of forceps used in delivery

A

Kiellands forceps
Simpsons forceps
Short forceps (Wrigley’s)

46
Q

Which forcep is used for ritationa and extraction in delivery

A

Kiellands Forceps

47
Q 
Which Forceps is used for midcavity assisted delivery without the need for rotation 
Max diameter (5-8cm) above vulva
A

Simpsons forceps

48
Q

Which forceps is used for low extraction when the maximum diameter is about 2.5cm above vulva

A

Short Forceps (Wrigleys)

49
Q

What are the four classifications of forceps application in delivery

A

Outlet forceps
Low forceps
Mid forceps
High forceps

50
Q

What is the description for classification of outlet forceps application

A

Foetal scalp visible without separating vulva
Foetal skull has reached pelvic floor
Sagittal suture is in the A P diameter
Ritation does not exceed 45 degrees

51
Q

What is the description for classification of low forceps application

A

Leading point of the skull is 2cm or more below ischeal spine but not on pelvic floor

52
Q

What is the description for classification of mid forceps application

A

Leading point of the skull is 2 cm of less above the spine but head is engaged.
Rotation not considered

53
Q

What are two indications for forceps delivery

A

Due to uterine inertia

Failure of progress of labour (if no progress occurs for more than 20-30 mins, with the head on the perineum)

54
Q

What is the time used to declare prolonged second stage of labour in the nulliparous woman with regional anaesthesia?

A

<3 hrs

55
Q

What is the time used to declare prolonged second stage of labour in the nulliparous woman without regional anaesthesia?

A

<2 hrs

56
Q

What is the time used to declare prolonged second stage of labour in the multiparpus woman with regional anaesthesia?

A

<2hrs

57
Q

What is the time used to declare prolonged second stage of labour in the multiparous woman without regional anaesthesia?

A

<1hr

58
Q

List five fetal indications for forceps delivery

A

Foetal distress in second stage when prospect of vaginal delivery is safe

Cord prolapse in second stage

After coming head of breech

Low birth weight baby

Post maturity

59
Q

What are six maternal indications for forceps delivery

A 
Maternal distress 
Pre-eclampsia
Post caesarean pregnancy 
Heart diseases
Intra partum infection
Neurological disorders (where voluntary efforts are contraindicated or impossible)
60
Q

List the steps in the procedure for a forceps delivery

A

1) Explain to the patient what is about to happen
2) Bladder is catheterized
3) regional anesthesia is given
4) each blade is slipped beside the fetal head
5) The vagina is guarded by the operators hand
6) When correctly sited, the handles should lock
7) Gentle traction in the correct line of pull
8) once head is crowned, the blades can be removed and the rest of the baby delivered normally

61
Q

When is Trial Forceps Delivery done?

A

Knowing that a certain degree of disproportion at mid pelvis may make the procedure impossible

62
Q

Where is the the Trial Forceps Delivery Attempted

A

In the Operating Theatre

63
Q

What type of forceps is used to attempt Trial Forceps Delivery

A

Low / mid forceps delivery

64
Q

If the doctor sees that the Trial Forceps Delivery attempt will not be successful when should he abandon

A

At the earliest stage in favour of Caesarean Section

65
Q

What are the six prerequisites for Forceps Delivery

A 
Suitable presentation and position
Cervix must be fully dilated
Membranes must be ruptured
Baby should be living
Uterus must be contracting and relaxing 
Bladder must be empty 
No obvious bar exits to delivery
Episiotomy 
Analgesia
66
Q

What are the suitable presentations and positions for Forceps Delivery

A

Vertex
Aftercoming head
Anterior face

67
Q

Which Analgesia is administered for the Forceps Delivery

A

Lignocaine pudendal block with infiltration to vulva (for mid cavity forceps )

Epidural or spinal (for rotation forceps)

68
Q

List six Complications/dangers of Forceps Delivery

A 
Injury
Post partum hemorrhage 
Shock
Sepsis
Anaesthetic hazards
Delayed or long term sequel
69
Q

Which injuries might the mither succum during Forceps Delivery

A

Extension of Episiotomy involving anus and rectum or vaginal vault

Vaginal lacerations and cervical tear if cervix was not fully dilated

70
Q

What are four Fetal Complications or Dangers after Forceps Delivery

A

Asphyxia
Trauma
Remote- cerebral palsy
Foetal death- around 2%

71
Q

A vacuum extractor is rarely used for the first stage of labour

If, however, there was an indication to use it what would those indications be

A

Fetal distress after cervix is 8cm dilated in a multiparous woman

Lack of advance after 8cm dilation in a multiparous woman

72
Q

A vacuum extractor is more commonly used during the second stage of labour

What are the indications

A

Lack of advance often with occipito-posterior or occipito transverse position

After an epidural has relaxed the pelvic floor

If the mother is tired

If the head of the second twin is high

73
Q

List the steps in the procedure for a Vacuum Extraction Delivery

A

Use the largest possible cap
Should lie flat against fetal head
Check to ensure no part of the vaginal wall has been sucked in
The cap is held on to the head with the left hand as traction is applied with the right hand
Correct line of pull very important to prevent the cap coming off
Early episiotomy

74
Q

List three complications of Vacuum Extraction Delivery

A

Damage to cervix of not fully dilated to vaginal wall

Haematoma of baby’s scalp

Scalp abrasions

75
Q

List four Indications of episiotomy

A

Speed later part of the second stage of labour in presence of fetal distress

Open up posterior areas to allow correct line of traction at forceps extraction

Overcome a perineum that is rigid and delaying last part of delivery

If there is likely to be a major perineal tear

76
Q

Describe stage 1 perineal tear

A

Skin of fourchette or vagina only

77
Q

Describe Stage 2 Perineal Tear

A

Skin and Superficial Perineal Muscles

78
Q

Describe Stage 3 perineal Tear

A

Anal and muscles and sphincter involved

79
Q

Risks of Episiotomy

A

Substantially increases

  • Maternal blood loss
  • average depth of posterior perineal injury
  • risk of anal sphincter damage and its attendant long term morbidity
  • risk of improper perineal wound healing
  • amount of pain in first several postpartum days

Urogenital System (17 decks)

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