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Obstetrics > Intrapartum Care: Operative Delivery > Flashcards

Intrapartum Care: Operative Delivery Flashcards

(70 cards)

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1
Q

What is operative vaginal delivery

A

Use of instruments to delivery foetus

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2
Q

How many attempts are you allowed with instruments

A

3 attempts

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3
Q

What are 3 maternal indications for operative delivery

A
  • Exhaustion
  • Co-morbidities
  • Inadequate progress
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4
Q

What are 2 foetal indications for instrumental delivery

A
  • Suspected foetal compromise

- Clinical concerns (eg. antepartum haemorrhage)

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5
Q

What are 4 absolute contraindications for instrumental delivery

A
  1. Breech
  2. Cephalo-pelvic disproportion
  3. Incompletely dilated cervix
  4. Unengaged head
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6
Q

What are 2 absolute contraindications of ventouse delivery

A

<34W

Coagulation abnormalities

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7
Q

What is a mnemonic to remember requirements of operative delivery

A

FORCEPS

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8
Q

What are requirements for operative delivery

A 
Fully-dilated cervix 
Obstruction excluded
Ruptured membranes
Consent, catheterise 
Epidural
Position
Station, senior help
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9
Q

What are two instruments used in operative deliveries

A

Ventous

Forceps

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10
Q

What is a ventouse

A

Suction cup is applied to babies head via vacuum

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11
Q

What type of venous can be used for all foetal positions

A

Kiwi

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12
Q

Where is the venous applied

A

Flexion point

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13
Q

What is the flexion point

A

Midline, 3cm anterior to the posterior fontanelle

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14
Q

What are two advantages of ventouse

A
  • Decrease incidence 3rd and 4th degree tears

- Perform with less knowledge about babies head

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15
Q

What are 4 disadvantages of ventouse

A
  • Cephalohaematoma
  • Lower success rate
  • Increases subgleal haemorrhage
  • Increases foetal retinal haemorrhage
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16
Q

What 3 complications does ventouse increase risk of

A
  1. Cephalohaematoma
  2. Subgleal haemorrhage
  3. Retinal haemorrhage
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17
Q

What is subgleal haemorrhage

A

bleeding between smbgaleal aponeurosis and periosteum

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18
Q

What forceps are used for ocipito-anterior posterior

A

Rhodes
Simpsons
Neville-Barnes

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19
Q

What forceps are used for C-section

A

Wrigley’s

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20
Q

What is the advantage of forceps

A

Higher success rate

Does not require maternal effort

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21
Q

What are 4 complications of forceps

A

Caput succedum
Facial nerve palsy
Soft-tissue scalp trauma
Higher rate tears

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22
Q

What is caput succedaneum

A

Oedema of the scalp

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23
Q

How does caput succedaneum present

A
  • Swelling present at birth
  • More common over the vertex
  • Crosses suture lines
  • Resolves in days
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24
Q

Where does caput succedaneum form

A

Vertex

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25
What is the relationship between caput succedaneum and suture lines
crosses suture lines
26
When does caput succedaneum resolve
Within days
27
What is a cephalohaematoma
Collection of blood between periosteum and skull
28
Describe presentation of cephalohaematoma
Swelling parental region that appears hours after birth and does not cross suture lines
29
Does cephalohaematoma cross suture lines
No
30
What is often associated with cephalohaematoma
Jaundice
31
How long does cephalohaematoma take to resolve
3-months
32
How are c-sections classified
Category 1-4
33
What is a category 1 c-section
Emergency = Immediate threat to maternal or foetal life
34
How soon should a foetus be delivered in category 1 c-section
30 minutes
35
What is a category 2 c-section
Compromise, but no immediate threat to maternal or foetal life
36
What is the time frame to deliver category 2 c-section
60-75m
37
What is category 3 c-section
Early delivery
38
What is category 4 c-section
Elective
39
When are elective C-sections usually planned for and why
>39W to reduce respiratory distress
40
What is mendelson's syndrome
aspiration of gastric acid during pregnancy
41
What is given during LSCS to prevent mendelsons syndrome
ranitidine and pro-kinetic antiemetic (metclopramide)
42
What position is a women put in for C-section
left lateral at 15'
43
Why is women put in left-lateral position
to prevent aorta-caval syndrome: compression of abdominal aorta and IVC by uterus
44
What incisions are made for c-section
Pfannistiel or Joel-cohen
45
What is given to aid delivery of placenta following c-section
Oxytocin
46
What is an immediate complication of c-section
PPH Wound haematoma Intra-abdominal haemorrhage Bladder/Bowel perforation TTN
47
What are intermediate complications of c-section
Infection
48
What are long-term complications of c-section
``` VBAC Scar Psychological Future placenta praevia Sub-fertility: takes a longer time to get pregnant again ```
49
What are the two options for women who has had a previous C-Section
1. Elective c-section | 2. VBAC
50
What do RCOG say about VBAC
vaginal deliveries are safe for women who have had one previous c-section. With success rates of 72-75%
51
What is the most concerning risk of VBAC
Uterine rupture
52
What does c-section increase risk of
Transient Tachypnoea newborn
53
Define uterine rupture
Rupture uterine muscle and overlying serosa
54
What is the biggest risk factor for uterine rupture
Previous C-Section
55
What type of c-section has the highest risk of uterine rupture
Classical scar
56
What are 6 risk factors for uterine rupture
1. C-section 2. Uterine surgery 3. Obstruction labour 4. Multiparous 5. Multiple pregnancy 6. Induction with prostaglandins
57
What should be avoided in VBAC
Inducing labour
58
What are two absolute contriandications to VBAC
1. Classical C-section | 2. Previous uterine rupture
59
What is a relative contraindication to VBAC
More than 2 c-sections
60
What is an episiotomy
surgical incision to increase diameter of vaginal Introits
61
When may episiotomy be required
Complicated vaginal delivery - ventouse or forceps FGM
62
Explain episiotomy procedure and why
Scissors used to cut laterally to posterior fourchette to prevent tearing of anal sphincter
63
What tissues are cut in episiotomy
Vaginal epithelium Perineum Bulbocavernousus muscle Superficial, deep and transverse muscles
64
What should be performed after an episiotomy
Rectal exam - to check rectal mucosa intact
65
What may be given as analgesia post episiotomy
Rectal diclofenac
66
What is oxytocin used for in labour
Induction | Active management third stage
67
What is the MOA of oxytocin
Stimulate uterine contractions
68
What are prostaglandins used for
Induce labour
69
What is the MOA of prostaglandins
Increase cervical effacement and uterine contraction
70
What can be used to prevent premature labour
Terbutaline or salbutamol (B2 agonist)

Obstetrics (27 decks)

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