Instrumental and operative

Question 1

FORCEPS

Answer 1

fully dilated cervix
Occiput anterior
Rupture of membranes
cephalic presentation
engaged presenting part not palpable abdominally
pain relief
sphincter empty (catheter)

Question 2

when is an instrumental delivery indicated

Answer 2

maternal exhaustion

foetal compromise

factors which make it unsafe for mother to keep pushing

prolonged second stage of labour

Question 3

Maternal illness that makes SVD dangerous

Answer 3

• Cardiac disease
  
  • HTN
  • Aneurysm
  • Glaucoma

Question 4

• Prolonged second stage of labour
  nulliparous women

Answer 4

• 2 hours (with epidural), 3 hours (without epidural)

Question 5

Prolonged second stage of labour
multiparous women

Answer 5

• 1 hour (with epidural), 2 without in multiparity

Question 6

what form of instrumental is better for mother

Answer 6

ventous

Question 7

what instrumental delivery is worse / has more complications for mother?

Answer 7

Forceps

Question 8

foetal complication of instrumental delivery?

Answer 8

cephalohaematoma
chignon
scalp laceration
facial nerve palsy / damage
neonatal jaundice
intracerebral haemorrhage

Question 9

maternal complications?

Answer 9

• Vaginal laceration
  
  • Blood loss
  • Third degree tears

Question 10

what is non rotational forceps?

Answer 10

○ Simpsons
○ Neville barnes

Only use if occiput is anterior

Question 11

rotational forceps?

Answer 11

Kielland’s
Allow malpositioned head to be rotated by operator to OA

Question 12

cephalohaematoma is when blood collects where?

Answer 12

sub-periosteal space

due to damage to blood vessels

(heals itself) noticed as a bulge

Question 13

risks associated with c section?

Answer 13

• Haemorrhage
• Blood transfusion
• Infection
• VTE
• 1 in 5000 die

Question 14

what is a prolonged first stage defined as?

Answer 14

> 12 hours not fully dilated

Question 15

after ERCS when can you get pregnant?

Answer 15

not for 12-18 months

Question 16

is thromboprophylaxis needed after a ERCS?

Answer 16

yes

Question 17

what is success rate of VBAC?

biggest signifier of success?

Answer 17

72-75%

previous VBAC (successful)

Question 18

contraindications to VBAC?

Answer 18

classical c section scar
uterine rupture
praevia

Question 19

what are the risks associated with c section?

Answer 19

haemorrhage
Blood transfusion
infection
VTE

Question 20

if head is OP what can you use to aid delivery?

Answer 20

Forceps - Kiellands
allows malpositioned head to be rotated

Question 21

C section layers?

Answer 21

skin
fatrectus sheath
rectus muscle
peritoneum
abdominal cavity
loose peritoneum
lower segment

Question 22

what thromboprophylaxis is used in pregnANCY?

Answer 22

LMWH

Question 23

can a SVD be offered in placenta praevia?

Answer 23

yes ONLY if grade 1

Question 24

conservative management for a worrying CTG ?

Answer 24

position - left lateral position)

consider tocolysis in uterine hyperstimulation

Question 25

foetal scalp sample 7.2-7.25?

Answer 25

conservative measurements then reassess in 20-30 mins

Question 26

foetal scalp sample <7.2?

Answer 26

c section

Question 27

main complication of IoL?

Answer 27

uterine hyperstimulation offer tocolysis?

Question 28

what is uterine hyperstimulation? what is it caused by?

Answer 28

high contraction frequency and duration >20 mins so more than 4 every 10 mins IoL - misoprostolol

Question 29

what are the indications for IoL?

Answer 29

prolonged pregnancy pprom diabetic mother >38 weeks pre-eclampsia IHC of pregnancy

Question 30

bishop score cervical effacement? 3 points

Answer 30

80%

Question 31

bishop score cervical effacement? 2

Answer 31

60-70%

Question 32

bishop score cervical effacement? 1 point

Answer 32

40-60%

Question 33

Bishop score cervical dilation 1 2 3

Answer 33

1-2 cm 3-4cm >5cm

Question 34

foetal station - bishops score

Answer 34

1- -2 2: -1/0 at ischial spines 3: +1,2 below spines

Question 35

cervical position

Answer 35

0- posterior 1-intermediate 2-anterior