Assisted Vaginal Delivery & Perineal Injury Flashcards Preview

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Flashcards in Assisted Vaginal Delivery & Perineal Injury Deck (13):
1

What are the indications for assisted delivery? (categorise)

Maternal Indications:
-Exhaustion
-Inadequate expulsion efforts (Neuromuscular/spinal cord injury)
-Need to avoid maternal expulsion effort (cardiac/cerebrovascular disease)

Fetal Indications:
-Fetal Distress

Other:
-Prolonged stage 2 of labour:
Nulliparous = > 2hours
Multiparous = >1 hour

Note: if with regional analgesia increase by 1hr before abnormal

2

What are the requirements which must be met before assisted delivery can be undertaken?

Maternal:
Consent
Analgesia
Emptied bladder
Lithotomy position

Fetal:
Vertex presentation and engaged
Station >+2

Uteroplacental:
Cervix fully dilated
Membranes ruptures
No placenta previa


Note, placenta previa = a condition in which the placenta partially or wholly blocks the neck of the uterus, so interfering with normal delivery of a baby.

3

What are the different classifications of forceps and give examples?

Classic forceps which have a pelvic or cephalic curvature:
Tucker-Mclane
Simpson
Elliott

Rotational forceps which allow rotation to the OA position:
Kielland

Forceps designed to assist breech delivery:
Piper forceps

4

What are the potential complications associated with forceps delivery?

Increased maternal trauma (including anal sphincter)
Rotational forceps often cause vaginal tears

Fetal Injuries:
CNVII palsy
Skull fracture
Orbital injury
Inter cranial haemorrhage

5

What are the potential complications associated with Ventouse delivery?

Ventouse = suction

Fetal injury:
Scalp lacerations
Cephalohaematoma
Temporary swelling on the head (chignon)
Retinal haemorrhage
Neonatal jaundice

Rarely inter cranial haemorrhage

6

What factors play a decision in the type of assisted delivery?

Position and descent of the head.

If head is OT/OP use either Kielland forceps or ventouse.

If the head is at or just below the IS aka station 0/+1 mother will need an epidural and spinal and there must be a theatre ready in case a emergency CS is needed.

7

What factors are predisposing for needing an assisted delivery?

Nulliparous (20%)
Epidural analgesia
An induced labour
Abnormal CTG

8

What are the risk factors for a failed assisted delivery?

BMI>30
Estimated fetal weight >4kg
OP
Mid cavity delivery/head is > 1/5 palpable abdominally

9

What is an episiotomy, what are the different types?

A surgical incision into the perineum to facilitate delivery.

Can be done by 2 incisions:

Mediolateral: Incision at 45 degree to the posterior forchette. Less perineal trauma but antidotally increase blood loss, wound infection and pain.

Midline: Vertical midline incision from the posterior forchette to the rectum. Associated with increased perineal trauma involving the anal sphincters.

10

What are the indications for episiotomy?

Breech if not going CS
Shoulder dystocia
Assisted delivery (forceps/ventouse)
Fetal Distress

Extensive lower genital tract scarring
Poorly healed 3/4th degree tears

11

What are the complications of episiotomy?

Bleeding and haematoma
Pain
Infection
Scarring
Dyspareunia (painful sex)
Rarely fistula formation

12

What are the different classifications of perineal tear?

1st degree: Vaginal mucosa
2nd degree: Subcutaneous tissue
3rd degree: External anal sphincter involvement
4th degree: Internal anal sphincter involvement

13

What is the mangement of perineal tears and episiotomy?

1st and 2nd degrees/uncomplicated episiotomy:
Sutured under local anaesthetic. Continuous sutures for muscle and subcuticular for skin.

3rd and 4th degree tears:
-Repaired under epidural or spinal analgesia in theatre.
-Prophylactic Abx and laxatives are used.
-Anal manometry is used to check pressures exerted by anal sphincters.
-Review at 6 weeks
-30% suffer form long term flatulence/urgency/incontinence