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Urogenital System > 4. Operative obstetrics > Flashcards

4. Operative obstetrics Flashcards

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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
List the steps to the Caesarean Section
``` 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 ```
26
In C section After The bladder is drained with in dwelling catheter Which step is next
Open abdomen
27
In C section After opening the abdomen Which step in next
Expose lower uterine segment
28
In c section | After exposing the uterine segment which step is next
Incise Visceral Peritoneum
29
In C section after you incise the visceral peritoneum, which step is next
Push bladder down
30
In c section after you push the bladder down, which step is next
Open uterus with a transverse incision
31
In C section after you open the uterus with a transverse incision Which step is next
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
32
Which drug is administered during and immediately after delivery of a baby to help the birth and to prevent or treat excessive bleeding
Syntometrine
33
How does Syntometrine work
It works by stimulating the muscles of the uterus (womb) to produce rhythmic contractions
34
When is a vertical uterine incision used in c section
If the lower segment is unapproachable because of fibroids If Transverse fetal lie with the back inferior If lower segment is not formed
35
What are the two types of regional block administered during a Caesarean Section
Spinal (fastest and densest block) | Epidural (allows postoperative top ups for continuing pain relief)
36
Why is general anaesthesia avoided for c section
incidence of complications postoperatively are higher than those of Regional blocks
37
What are some complications of General Anaesthesia during c section
Aspiration of stomach contents Chest infections Thrombosis
38
What are three main indications for General Anaesthesia
Maternal Anxiety Operation likely to be complicated Emergency, when insufficient time to establish epidural or spinal block
39
List four complications of c section
Haemorrhage Infection Ileus Thrombosis
40
What is used to reduce risk of infection after C section
Prophylactic antibiotics
41
How do you treat ileus after c section
With IV fluids and no oral fluids until after the mother has passed flatus
42
The risk of a c section pt developing thrombosis is how much greater than than of a vaginal delivery pt
8x
43
Thrombosis after c section commonly occurs where
Leg or Pelvic Veins
44
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)
Prophylactic anticoagulant
45
List three types of forceps used in delivery
Kiellands forceps Simpsons forceps Short forceps (Wrigley’s)
46
Which forcep is used for ritationa and extraction in delivery
Kiellands Forceps
47
``` Which Forceps is used for midcavity assisted delivery without the need for rotation Max diameter (5-8cm) above vulva ```
Simpsons forceps
48
Which forceps is used for low extraction when the maximum diameter is about 2.5cm above vulva
Short Forceps (Wrigleys)
49
What are the four classifications of forceps application in delivery
Outlet forceps Low forceps Mid forceps High forceps
50
What is the description for classification of outlet forceps application
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
What is the description for classification of low forceps application
Leading point of the skull is 2cm or more below ischeal spine but not on pelvic floor
52
What is the description for classification of mid forceps application
Leading point of the skull is 2 cm of less above the spine but head is engaged. Rotation not considered
53
What are two indications for forceps delivery
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
What is the time used to declare prolonged second stage of labour in the nulliparous woman with regional anaesthesia?
<3 hrs
55
What is the time used to declare prolonged second stage of labour in the nulliparous woman without regional anaesthesia?
<2 hrs
56
What is the time used to declare prolonged second stage of labour in the multiparpus woman with regional anaesthesia?
<2hrs
57
What is the time used to declare prolonged second stage of labour in the multiparous woman without regional anaesthesia?
<1hr
58
List five fetal indications for forceps delivery
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
What are six maternal indications for forceps delivery
``` Maternal distress Pre-eclampsia Post caesarean pregnancy Heart diseases Intra partum infection Neurological disorders (where voluntary efforts are contraindicated or impossible) ```
60
List the steps in the procedure for a forceps delivery
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
When is Trial Forceps Delivery done?
Knowing that a certain degree of disproportion at mid pelvis may make the procedure impossible
62
Where is the the Trial Forceps Delivery Attempted
In the Operating Theatre
63
What type of forceps is used to attempt Trial Forceps Delivery
Low / mid forceps delivery
64
If the doctor sees that the Trial Forceps Delivery attempt will not be successful when should he abandon
At the earliest stage in favour of Caesarean Section
65
What are the six prerequisites for Forceps Delivery
``` 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
What are the suitable presentations and positions for Forceps Delivery
Vertex Aftercoming head Anterior face
67
Which Analgesia is administered for the Forceps Delivery
Lignocaine pudendal block with infiltration to vulva (for mid cavity forceps ) Epidural or spinal (for rotation forceps)
68
List six Complications/dangers of Forceps Delivery
``` Injury Post partum hemorrhage Shock Sepsis Anaesthetic hazards Delayed or long term sequel ```
69
Which injuries might the mither succum during Forceps Delivery
Extension of Episiotomy involving anus and rectum or vaginal vault Vaginal lacerations and cervical tear if cervix was not fully dilated
70
What are four Fetal Complications or Dangers after Forceps Delivery
Asphyxia Trauma Remote- cerebral palsy Foetal death- around 2%
71
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
Fetal distress after cervix is 8cm dilated in a multiparous woman Lack of advance after 8cm dilation in a multiparous woman
72
A vacuum extractor is more commonly used during the second stage of labour What are the indications
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
List the steps in the procedure for a Vacuum Extraction Delivery
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
List three complications of Vacuum Extraction Delivery
Damage to cervix of not fully dilated to vaginal wall Haematoma of baby’s scalp Scalp abrasions
75
List four Indications of episiotomy
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
Describe stage 1 perineal tear
Skin of fourchette or vagina only
77
Describe Stage 2 Perineal Tear
Skin and Superficial Perineal Muscles
78
Describe Stage 3 perineal Tear
Anal and muscles and sphincter involved
79
Risks of Episiotomy
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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