Obstetrical Procedures Flashcards by Jessica Shine

What is a 1st degree perineal laceration?

Superficial perineal skin or vaginal mucosa

How well did you know this?

Not at all

Perfectly

What is a 2nd degree perineal laceration?

Perineal muscles and facia

How well did you know this?

Not at all

Perfectly

What is a 3rd degree perineal laceration?

Anal sphincter

How well did you know this?

Not at all

Perfectly

What is a 4th degree perineal laceration?

Rectal mucosa

How well did you know this?

Not at all

Perfectly

What do you need to know about episiotomy?

Midline or mediolateral (MLE inc 3rd/4th lac)

Comparable to 2nd degree lac

How well did you know this?

Not at all

Perfectly

Is vacuum or forceps easier on mom/baby?

Vacuum easier on mom

Forceps easier on baby

How well did you know this?

Not at all

Perfectly

What are the prerequisites for an operative vaginal delivery?

Engaged fetal vertex
Ruptured/fully dilated 
Precisely known position
Drained bladder
Informed consent

How well did you know this?

Not at all

Perfectly

What are the indications for an operative vaginal delivery?

Prolonged second stage
Immediate/potential fetal compromise
Category II or III tracing
Shorten 2nd stage for maternal benefit (exhaustion, cardiopulmonary or cerebrovascular disease)

How well did you know this?

Not at all

Perfectly

What is considered prolonged 2nd stage in nulliparous/multiparous women?

Nulliparous: lack of continuing progress for 3 hours with analgesia, 2 hours without

Multiparous: lack of continuing progress for 2 hours with analgesia, 1 hour without

How well did you know this?

Not at all

Perfectly

What is an outlet operative vaginal delivery?

When the scalp is visible at the introitus without separating labia

Fetal skull has reached pelvic floor

Saggital suture in AP diameter or left/right occiput anterior/posterior

Rotation does not exceed 45 degrees

How well did you know this?

Not at all

Perfectly

What is a low operative vaginal delivery?

Leading point of fetal skull is > or = +2, not on pelvic floor

How well did you know this?

Not at all

Perfectly

What is a midforceps delivery?

Station is above +2, head engaged

How well did you know this?

Not at all

Perfectly

What are the most serious complications of a forceps delivery?

Perineal and rectal lacerations

How well did you know this?

Not at all

Perfectly

What are common complications with a vacuum delivery?

Ceohalohematomas or worse hematomas

How well did you know this?

Not at all

Perfectly

A vacuum should not be used in fetuses less than ___ weeks

How well did you know this?

Not at all

Perfectly

When should a vacuum be stopped?

3 pulls over 3 ctx with no progress
3 pop offs without obvious cause
30 minutes elapsed time (some say 20)

How well did you know this?

Not at all

Perfectly

What are indications for a cesarean birth?

Concern for maternal/fetal well-being
Vaginal birth not possible/appropriate 
Placenta previa
Malpresentation
Multiples
Fetal intolerance
Labor dystocia
Preexisting medical conditions
Obstetric complications
Maternal request (only after 39wks)

How well did you know this?

Not at all

Perfectly

What types of skin/uterine incisions are done for a cesarean section?

Vertical or pfannenstiel (bikini) on skin

Low transverse, low vertical, classical, T, or J on uterus

How well did you know this?

Not at all

Perfectly

What are the maternal risks with a cesarean section?

Injury to adjacent organs (mostly bladder/bowel)
Hemorrhage
Wound infection
VTE
inc risk in future pregnancies

What are the fetal risks with cesarean section?

RDS

iatrogenic prematurity

What is the overall success rate for TOLAC in the U.S.?

60-80%

What is an ideal TOLAC candidate?

One or two previous low transverse c/s
Adequate pelvis
No other uterine scars or rupture
Physicians immediately available during active labor
Capable of continuous EFM

What is suspicious for uterine rupture?

Prolonged decels with severe variables
Inc bleeding
Hypotension
Tachycardia

What are the different options for mechanical cervical ripening?

Laminaria (seaweed absorbs water, expands)

Lamicel/dilipan (polymers absorb water, expand, may cause production of prostaglandins

Balloon catheters (foley or cook)

What is prostaglandin E1?

``` Cytotec 25mcg Cheap Don't redose if 2 or more ctx in 10 min Contraindicated with prior uterine surgery ```

What is prostaglandin E2?

Cervidil Continual release- need continuous EFM remove after 12 hours Expensive

What are options for mechanical induction of labor?

Membrane stripping- digital separation of chorioamniotic membrane from cervix to release prostaglandins and endogenous oxytocin Amniotomy- can inc occurrence of infection and variable decels

What is the half life and plasma steady state of oxytocin?

10-15 minutes | 40 minutes

What do you need to know about oxytocin infusion?

Should be stopped when labor is established Given via pump, IV piggyback to lowest port Continuous EFM AWHONN recommends 1:1 nursing care

What do you do if you have tachysystole and a category I tracing?

``` Reposition IVF bolus Wait 10-15 minutes Decrease by half Reposition IVF bolus Wait 10-15 minutes Turn off ```

What do you do if there is tachysystole and a category II or III tracing?

Stop oxytocin

Once tachysystole is resolved after stopping oxytocin, what do you restart at?

Off for less than 30 minutes? Restart at half | Off for 30 minutes or more? Restart at initial

How is oxytocin similar to ADH?

Can cause electrolyte imbalance resulting in water intoxication

What are the opioid analgesia options in labor?

Demerol- can cause resp depression Nubain- less resp depression, more sedation *not to be given to opiate dependent pts Stadol- similar to Nubian, pseudosinusoidal Fentanyl- fast onset, short acting

Can an epidural cause a maternal fever?

Yes

Does an epidural increase the need for pit?

Yes

Does an epidural increase the length of second stage?

Yes

What is local infiltration?

Local injected into perineum, labia, vagina

What is paracervical anesthesia?

Anesthetic injected into cervix Profound fetal bradycardia Rarely used

What is pudendal anesthesia?

Local anesthetic injected just below ischial spines

A bishop score of ___ or more indicates need for cervical ripening

What do you need to know about external cephalic version?

Done between 37-39 wks Rh negative women need rhogam 65% success rate Forward roll more successful than backflip Tocolysis does not significantly improve success

What are the bishop scores given for effacement?

0-30: 0 40-50: 1 60-70: 2 80 or more: 3

What are the bishop scores given for dilation?

0: closed 1: 1-2cm 2: 3-4cm 3: 5 or more cm

What are the bishop scores for station?

0: -3 1: -2 2: -1 3: +1, +2