Malposition In 2nd Stage Tog 25

Question 1

M.c indication for Kirkland forceps in recent times

Answer 1

Deep transverse arrest

Question 2

Indications for using kiellend forceps

Answer 2

1 ) deep transverse arrest (Most common ) .
2) mid cavity rotation of OP
3) face presentation
4 ) delivery of the after coming head in breech delivery .

Question 3

How to distinguish KF

Answer 3

1 ) minimal pelvic curve
2 ) sliding lock
3 ) small metal knobs on the handle should always point toward the occiput .

Question 4

Sliding lock on the forceps is used for

Answer 4

Correction of the asynclitisim

Question 5

Define asynclitism

Answer 5

Lateral flex ion of the head , which results in losing parallelism between the axis of the fetal head and the pelvic plane .

Question 6

Degrees of the rotation in case of rotating occipitoposterior to oa

Answer 6

180 degrees for true op

Question 7

When you should do rotation
With cons or without

Answer 7

Should be done exclusively during contractions .

Question 8

What Type of force should be applied for the forceps

Answer 8

Never use excessive force only fingertip force .

Question 9

Highest risk for OASIS among all OVDs

Answer 9

Is with KF

Question 10

Most appropriate method for rotation in case of malposition in the right hand in presence of expert an trained obstetrician and both decision making an technical components ,

Answer 10

KF decreases the risk of ERCS

Question 11

When can you use MROT?

Answer 11

At the beginning of the 2nd stage or at fully or not fully dilated cervix ,
Or after a prolonged 2nd stage for labor

Question 12

When can you do MROT during with or without contraction

Answer 12

In between cxns or when the patient is actively pushing .

Question 13

Problems associated with MROT are

Answer 13

1) returning back to malposition ( between MROT and forceps or vacuum application which came lead to wrong application )
2) cord prolapse
Recognized cases also of
1) skull fracture
2 ) vaginal trauma.

Question 14

What increased the safety of the cs

Answer 14

The prophylactic use of antibiotics , thrmoboprophylaxis and enhanced recovery

Question 15

Complications associated with P EMCS at the 2nd stage of labor

Answer 15

Massive pph requiring blood transfusion .
Uncommon visceral injury risk which increases with no of previous cs .
Also sepsis and uterine tears are more common with 2nd stage cs

Question 16

Infra op complications ar more common in 2 nd stage or 1st date CS , rate of it is

Answer 16

4.6 times more intro op complications in case of 2ns stage Pemcs
3 times more risk of blood transfusion
And risk of pph > 1 L

Question 17

Mention not immediate complications of pEMCS

Answer 17

Longer hospital stay
Increased risk of thromboembolism
Lack of long term protection of pelvic floor function

Question 18

Steps in the cs if the fetal head is deeply engaged

Answer 18

1 ) stand on a step or table down
2 table is tilted with te women head down
3 wait for cxn to cease
4 call for help
5 deliver with the opposite hand
6 250 mg terbutaline sub Q or ga
7 pressure on the shoulder
Push the head upward vaginally
Evaluate the incision make it T or j shaped for easier delivery of the baby
And deliver as breech

Question 19

What to do as next step if the head is disimapcted and moved superiorly

Answer 19

Maintain longitdunal axis
Apply pressure from above
Deliver the head using forceps
Deliver the breech