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O&G > Obstetric Procedures > Flashcards

Obstetric Procedures Flashcards

(48 cards)

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1
Q

What is Evacuation of Retained Products of Conception (ERPC)?

A

Surgical procedure to remove ‘retained products of conception’ after delivery, miscarriage or TOP

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2
Q

What are the indications for ERCP?

A
  • Miscarriage (maternal preference or necessity)
  • Persistent bleeding, haemodynamic instability
  • Gestational trophoblastic disease (suspected)
  • Infected products of conception after ABx
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3
Q

What are the complications of ERCP?

A

Generic: bleeding, infection, procedural failure, necessity to repeat

Specific: intrauterine adhesions, perforation of uterus (0.5%)

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4
Q

What is External Cephalic Version (ECV)?

A

External manipulation of foetus through maternal abdomen to achieve a cephalic presentation

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5
Q

What are the indications for ECV?

A

Breech presentation (persistent at 36 or 37 weeks)

  • Nulliparous - offered at 36 weeks
  • Multiparous - offered at 37 weeks + Tocolytics

Success rate = 50-60%

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6
Q

What are contraindications for ECV?

A

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
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7
Q

What are the complications of ECV?

A

There is a very low complication rate

  • Generic: procedural failure, necessity to repeat
  • Placental abruption
  • Uterine rupture
  • Foeto-maternal haemorrhage
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8
Q

What is CTG?

A

Cardiotocography – continuous monitoring of the foetal heart and uterine activity > used in labour

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9
Q

What are growth scans?

A

Booking scan at 12 (8-14) weeks, anomaly scan at 20 (18-21) weeks > monitor pregnancy

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10
Q

What is a foetal doppler?

A

Used to monitor FHR and should be placed over the anterior shoulder of foetus > monitor pregnancy

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11
Q

What is foetal blood sampling?

A

Blood withdrawn from umbilical vein to determine if severe anaemia caused by Rh sensitisation

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12
Q

What are the complications of foetal blood sampling?

A
  • Bleeding from site
  • Changes in FH
  • Infection
  • Leaking of amniotic fluid
  • Death of foetus (1%)
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13
Q

What are the indications for an emergency CS?

A
  • Terminal Bradycardia: FHR < 100 bpm for more than 10 mins
  • Terminal Deceleration: FHR drops and does not recover for more than 3 mins
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14
Q

What are the indications for an IUS?

A
  • Desire for long-term contraception
  • Menorrhagia
  • Endometriosis
  • HRT
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15
Q

What are the complications of IUD / IUS insertion?

A
  • 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
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16
Q

What is a ventouse?

A

Vacuum extractor cup placed directly over flexion point (better for mum but may upset baby)

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17
Q

What are forceps?

A

Smooth metal instruments fit around baby’s head (doesn’t upset baby)

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18
Q

What are the birth options after a previous CS?

A

VBAC – Vaginal Birth After CS

  • <34w GA > forceps

ERCS – Elective Repeat CS

  • > 34w GA > forceps OR ventouse
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19
Q

What are the indications for instrumental delivery?

A
  • Maternal exhaustion
  • Prolonged second stage of labour
  • Foetal distress
  • Maternal illness where bearing down is risky (cardiac conditions, HTN, aneurysm, glaucoma)
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20
Q

What are the indications for a CS?

Study These Flashcards
A
  • 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
21
Q

What are the requirements for instrumental delivery?

Study These Flashcards
A

(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)
22
Q

What are the CS categories?

Study These Flashcards
A
  • (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
23
Q

What are the CS incisions?

Study These Flashcards
A
  • Pfannenstiel
  • Joel-Cohen
  • Midline vertical/classical
  • Maylard
24
Q

What are the complications of instrumental delivery?

Study These Flashcards
A

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
25
What are the complications of CS?
- Generic: bleeding, infection, damage to local structures, procedural failure - Visceral damage – bladder (1 in 10,000), ureter, bowel - VTE - Foetal laceration - Hysterectomy – rare
26
What are absolute contraindications for VBAC?
- Previous uterine rupture - Classical (vertical) C-section scar - Normal non-C-section contraindications (e.g. major placenta praevia)
27
What are relative contraindications for VBAC?
- 2 or more previous CS - The need for IOL - Previous labour suggestive of cephalopelvic disproportion
28
What are the risks of VBAC?
- Emergency C-section (EMCS) - 25% - Planned VBAC has a 1 in 200 risk of uterine rupture (1 in 100 if syntocinon is used) - Increased risk of instrumental delivery (39%) - Infant: transient respiratory morbidity, still birth (very small)
29
What are the indications for safe VBAC?
Singleton, cephalic, >37 weeks, 1 previous C-section
30
What are the risks of ERCS?
- Placenta praevia/accreta - Pelvic adhesions - Neonatal respiratory morbidity (can be reduced with antenatal corticosteroids) - Longer recovery - Risk of bladder/bowel injury (rare) - Likely to need future LSCS (Lower Segment CS)
31
What are the benefits of ERCS?
- No risk of rupture - Able to plan recovery
32
How should ERCS be planned?
- ERCS should be conducted after 39 weeks (preterm VBAC has a lower risk of uterine rupture) - Antibiotics should be given before C-section - All women should receive thromboprophylaxis
33
How should a CS scar be cared for?
- Keep it dry and get sutures taken out after 5 days - No heavy lifting for 6 weeks - No getting pregnant for 12-18 months
34
What is CVS?
- Performed 10-13 wks (i.e. week 12) - 1% miscarriage rate - USS-guided needle aspirate of placental tissue - Foetal viability confirmed and anti- RHD given to Rh- women (sensitising event)
35
What is amniocentesis?
- Performed ≥15/40 - 1% miscarriage rate - USS guided needle, avoid entry of placenta, small aspirate of amniotic fluid - Foetal viability confirmed and anti-RhD given to Rh-neg women (sensitising event)
36
What are the indications for CVS / amniocentesis?
- Demonstrated risk at antenatal screening - Suspected foetal anomaly on USS - FHX of inherited disorder - Known carrier status for inherited disorder - Previous pregnancy with chromosomal disorder - Increased maternal age
37
What are the complications of CVS / amniocentesis?
- Generic: bleeding, infection, damage to local structures, procedural failure - Abdominal pain - Miscarriage (both CVS and amniocentesis at 1%) - Chorioamnionitis - Limb abnormalities if CVS performed before 10/40
38
What is sterilisation?
Surgical ligation or obstruction of both fallopian tubes as method of contraception: - Hysteroscopic sterilisation – expanding springs inserted into tubal ostia via hysteroscope  induce fibrosis - Tubal occlusion (laparoscopic procedure) – occlude fallopian tubes with Filshie clips
39
What advice should be given to women considering sterilisation?
- Method is irreversible (reversal requires high skilled and is difficult) - Vasectomy is safer, quicker and associated with less morbidity - High proportion of women regret sterilisation - Does not protect against STIs
40
What is required prior to sterilisation?
- Abstain from UPSI for 3 weeks and have a pregnancy test before the procedure - If the patient has had UPSI, the procedure should be deferred - Protected sex is ok
41
Is contraception still required after sterilisation?
- Laparoscopic procedure: the next menstrual period - Hysteroscopic procedure: 3 months
42
Can you get pregnant after sterilisation?
- Pregnancy following female sterilisation is rare but has an increased risk of ectopic pregnancy: - If missed period > immediate pregnancy test - If +ve > immediate USS to check location
43
What are the indications for sterilisation?
- Desire for permanent contraception (>99% effective) - Requires thorough counselling about nature of the procedure, risks, SE, irreversibility, alternative contraception
44
What are the complications of sterilisation?
- Generic: bleeding, infection, damage to local structures, procedural failure (1 per 200, 1% peripartum) - Increased risk of future ectopic pregnancy - Anaesthetic complications - VTE damage to other organs (bladder, bowel, vessels) - Risk of conversion to open procedure
45
Normal parameters for CTG?
Br = 110-160 A = 15bpm above baseline for 15s Va = 5-25bpm D = 15bpm below baseline for 15s
46
What is a pathological CTG?
1 abnormal feature, or 2 non-reassuring features
47
What are abnormal features on a CTG?
- Br <100 or >180 - Va <5 for 50 mins or >25 for 25 mins - Single prolonged deceleration >3 mins - Late decelerations for 30mins (less if RFs) - Variable decelerations with any concerning characteristics in >50% for 30 mins (less if RFs)
48
What are non-reassuring features of a CTG?
- Br 100-109 or 161-180 - Va >25 for 15-25 mins - Va <5 for 30-50 mins

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