Obstetric Procedures Flashcards
(48 cards)
What is Evacuation of Retained Products of Conception (ERPC)?
Surgical procedure to remove ‘retained products of conception’ after delivery, miscarriage or TOP
What are the indications for ERCP?
- Miscarriage (maternal preference or necessity)
- Persistent bleeding, haemodynamic instability
- Gestational trophoblastic disease (suspected)
- Infected products of conception after ABx
What are the complications of ERCP?
Generic: bleeding, infection, procedural failure, necessity to repeat
Specific: intrauterine adhesions, perforation of uterus (0.5%)
What is External Cephalic Version (ECV)?
External manipulation of foetus through maternal abdomen to achieve a cephalic presentation
What are the indications for ECV?
Breech presentation (persistent at 36 or 37 weeks)
- Nulliparous - offered at 36 weeks
- Multiparous - offered at 37 weeks + Tocolytics
Success rate = 50-60%
What are contraindications for ECV?
Absolute contraindications:
- Any requirement for C-section regardless
- Abnormal CTG
- APH <7 days
- Major uterine abnormality
- Ruptured membranes
- Multiple pregnancy
Relative contraindications: (ECV may be complicated)
- SGA
- Pre-eclampsia
- Oligohydramnios
- Major foetal abnormalities
- Scarred uterus
- Unstable lie
What are the complications of ECV?
There is a very low complication rate
- Generic: procedural failure, necessity to repeat
- Placental abruption
- Uterine rupture
- Foeto-maternal haemorrhage
What is CTG?
Cardiotocography – continuous monitoring of the foetal heart and uterine activity > used in labour
What are growth scans?
Booking scan at 12 (8-14) weeks, anomaly scan at 20 (18-21) weeks > monitor pregnancy
What is a foetal doppler?
Used to monitor FHR and should be placed over the anterior shoulder of foetus > monitor pregnancy
What is foetal blood sampling?
Blood withdrawn from umbilical vein to determine if severe anaemia caused by Rh sensitisation
What are the complications of foetal blood sampling?
- Bleeding from site
- Changes in FH
- Infection
- Leaking of amniotic fluid
- Death of foetus (1%)
What are the indications for an emergency CS?
- Terminal Bradycardia: FHR < 100 bpm for more than 10 mins
- Terminal Deceleration: FHR drops and does not recover for more than 3 mins
What are the indications for an IUS?
- Desire for long-term contraception
- Menorrhagia
- Endometriosis
- HRT
What are the complications of IUD / IUS insertion?
- Generic: bleeding, infection, procedural failure, necessity to repeat
- SE – heavier bleeding in first 2 weeks after insertion, pain, headache, nausea/vomiting, depression
- Perforation, infection, bleeding
What is a ventouse?
Vacuum extractor cup placed directly over flexion point (better for mum but may upset baby)
What are forceps?
Smooth metal instruments fit around baby’s head (doesn’t upset baby)
What are the birth options after a previous CS?
VBAC – Vaginal Birth After CS
- <34w GA > forceps
ERCS – Elective Repeat CS
- > 34w GA > forceps OR ventouse
What are the indications for instrumental delivery?
- Maternal exhaustion
- Prolonged second stage of labour
- Foetal distress
- Maternal illness where bearing down is risky (cardiac conditions, HTN, aneurysm, glaucoma)
What are the indications for a CS?
- Malpresentation
- Foetal distress
- Multiple pregnancy
- Failure to progress
- Placenta praevia
- Severe IUGR
- Placental abruption
- Infections (HIV, HSV)
- Cord prolapse
- Previous CS
- APH
- Previous anal sphincter injury
What are the requirements for instrumental delivery?
(FORCEPS) – an episiotomy will often be done first:
- F Fully dilated cervix
- O OA position (OP delivery is possibly with Keilland forceps and ventouse)
- R Ruptured membranes
- C Cephalic presentation
- E Engaged presenting part (NOT palpable abdominally)
- P Pain relief
- S Sphincter (bladder) empty (usually requires catheterisation)
What are the CS categories?
- (Cat 1) Immediate threat to life of woman or foetus
- (Cat 2) No immediate threat to life of woman or foetus
- (Cat 3) Requires early delivery
- (Cat 4) Elective CS
What are the CS incisions?
- Pfannenstiel
- Joel-Cohen
- Midline vertical/classical
- Maylard
What are the complications of instrumental delivery?
Maternal: (more common forceps)
- Perineal tears (3rd degree)
- Cervical and vaginal lacerations
- PPH
- 80% achieve SVD in subsequent pregnancy
Foetal: (more common ventouse)
Ventouse
- Cephalohematoma
- Intracerebral haemorrhage
- Retinal haemorrhage
- Jaundice
- Prolonged ventouse delivery = greatest risk of haemorrhage in the newborn
Forceps
- Facial nerve palsies