Operative Flashcards
(30 cards)
What are the indications for performing an episiotomy?
- Scar
- Short perineum
- Narrow sub pubic angle
- Macrosomia
- Malpresentation
- Pre maturity
- Most of primigravida
- Instrumental delivery (forceps - ventouse)
- Manipulative delivery
Indications emphasize the need for intervention in specific obstetric scenarios to prevent complications during delivery.
Compare median episiotomy and mediolateral episiotomy.
- Median episiotomy:
- Extension to anal sphincter
- Easier to repair
- Rare faulty healing
- Less pain in the perineum
- Dyspareunia is rare
- Less blood loss
- Mediolateral episiotomy:
- Extension to rectum is more common
- More difficult to repair
- Faulty healing is more common
- More pain in the perineum
- Dyspareunia is more common
- More blood loss
The comparison highlights the differences in surgical outcomes and recovery experiences between the two techniques.
What are the advantages of prophylactic episiotomy?
- Avoid perineal tears or stretch which may lead to prolapse
- Protect the rectum & anal canal from injury
- Easier repair & better healing than spontaneous tears
- Reduces the duration of 2nd stage of labor
- Avoid sudden compression decompression of the head (Intra cranial hemorrhage)
These advantages suggest that prophylactic episiotomy may improve maternal and fetal outcomes during delivery.
What are the disadvantages of prophylactic episiotomy?
- Blood loss
- More trauma than unassisted spontaneous vaginal delivery
- Dyspareunia & other complications
- Proposed benefits have never been proven
The disadvantages highlight the risks associated with the procedure, suggesting a need for careful consideration.
How can postoperative pain be decreased after an episiotomy?
- Use vicryl sutures (no fibrosis)
- Avoid tight sutures
- Avoid infection & hematoma formation by good hemostasis
- Provide postoperative analgesia
Effective pain management strategies can significantly enhance recovery after episiotomy.
What are common complications of episiotomy?
- Shock and anesthetic complications
- Infection: gapping, pain & dyspareunia
- Injury of fetal scalp, anal canal, Bartholin gland
- Bleeding (primary, reactionary, secondary due to infection)
- Bad repair: rectovaginal fistula, inclusion dermoid cyst, vaginal stenosis
- Pain: reflex retention of urine
Understanding complications is critical for preventing and managing adverse outcomes.
What structures are cut during an episiotomy?
- Vagina
- Perineal skin
- Bulbocavernosus muscle
- Superficial/Deep transverse perineal muscle
- Pubococcygeus or levator ani muscle
Knowledge of anatomical structures involved is essential for surgical preparation and technique.
What is the best time to perform an episiotomy?
After crowning
Timing is crucial to minimize complications and ensure effective intervention.
How should an episiotomy be repaired?
- Vagina: interrupted or continuous sutures, start above the apex
- Deep muscles (puborectalis of levator ani): interrupted sutures
- Superficial muscles: interrupted sutures
- Skin: subcuticular
- Post-operative care: antiseptic, analgesics, antibiotics, avoid soiling
Layered repair techniques are important for optimal healing and recovery.
What are the advantages of Kielland forceps over other forceps?
- Blades are longer
- Lighter
- Minimal pelvic curve
- Sliding lock to correct asynclitism
- Handles with 2 knobs for easy rotation
Kielland forceps are designed for better maneuverability and effectiveness during difficult deliveries.
What are the indications for forceps operation?
- Shortening of 2nd stage due to:
- Maternal disease (e.g., heart disease, eclampsia)
- Fetal distress
- Aftercoming head of breech
- Prolonged 2nd stage due to:
- Passenger malposition
- Minor degree of CPD
- Rigid perineum
- Weak uterine action
Recognizing these indications helps in decision-making during labor management.
What actions are performed with forceps during delivery?
- Traction
- Rotation
- Compression
- Vectis action
- Stimulation of uterine contractions
Understanding the actions of forceps is essential for effective use during complicated deliveries.
What are the types of forceps application?
- Cephalic
- Pelvic
- Cephalopelvic (best and safest)
Different types of forceps applications are tailored to specific fetal presentations and delivery needs.
What are the types of forceps operation?
- High forceps: head not engaged (obsolete)
- Mid forceps: engaged but doesn’t reach pelvic outlet (station above +2)
- Low forceps: immediately above pelvic floor but rotated (station +2, easiest & safest)
- Outlet forceps: reached pelvic floor and rotated
Familiarity with forceps types is crucial for safe and effective obstetric practice.
What are the prerequisites for forceps application?
- No cephalopelvic disproportion
- No soft tissue obstruction
- Bladder & rectum evacuated
- Cervix fully dilated
- Membranes ruptured
- Presenting part cephalic or aftercoming head of breech
- Head engaged, better deeply engaged (station below +2)
- Uterine contractions present
- Complete asepsis
- Anesthesia (general, epidural, or spinal)
Meeting these prerequisites ensures a safe and effective forceps delivery.
What are the complications associated with forceps delivery?
- Maternal:
- Tissue laceration
- UB fistula
- Prolapse
- Urethra injury
- Injury to pelvic joints & nerves
- PPH (Atonic or traumatic)
- Puerperal sepsis
- Fetal:
- Head injuries (skull bones, cephalhematoma)
- Injuries to eyes & ears
- Facial nerve and brachial plexus injuries
- Scalp and face injuries
- Intracranial hemorrhage
- Neonatal infection
- Asphyxia due to cord compression
Awareness of complications is essential for minimizing risks during forceps delivery.
What are the contraindications for ventouse use?
- Non-vertex presentation
- Intrauterine fetal death
- Severe fetal distress
- Premature babies (<36 weeks)
- Fetal coagulopathy
Recognizing contraindications is vital for ensuring safe delivery practices.
What complications can arise from ventouse delivery?
- Maternal: similar to forceps but less traumatic
- Fetal:
- Lacerations of scalp, ecchymosis, abrasions, tiny ulcers
- Scalp necrosis followed by scars
- Retinal hemorrhage
- Cephalhematoma (most common)
- Subgaleal hemorrhage due to emissary vein rupture
- Fracture skull bones
- Intracranial hemorrhage
Understanding potential complications aids in the management of ventouse-assisted deliveries.
What are the advantages of ventouse over forceps?
- Easy and gentle traction on the fetal head
- Promotes flexion & helps internal rotation in OP
- Less encroachment on maternal pelvis
- Decreased trauma to maternal birth canal
The advantages of ventouse technology can improve outcomes in certain delivery situations.
What are the advantages of forceps over ventouse?
- Faster extraction, shortening the 2nd stage
- Used in face and aftercoming head of breech
- Protects preterm fetus head
- Can be used for dead fetus
The advantages highlight the specific scenarios in which forceps may be preferred.
What are the indications for cesarean section?
- Previous CS
- Dystocia (passages, passenger)
- Complicated pregnancy (maternal or fetal distress)
Indications for cesarean delivery emphasize the need for surgical intervention in specific obstetric conditions.
What are the indications for upper segment cesarean section (USCS)?
- Impacted shoulder and obstructed labor
- Large fibroids, excessive varices, adhesions
- Previous successful repair of high vesicovaginal fistula
- Rarely cancer cervix
- Preterm labor with poorly formed lower segment
- Midtrimesteric hysterotomy
- Placenta previa
These indications guide surgical approach decisions based on anatomical and pathological considerations.
What are the indications for cesarean hysterectomy?
- Uterine atony with severe postpartum hemorrhage
- Couvelaire uterus
- Tumors associated with pregnancy (e.g., operable cancer cervix)
- Placenta accreta, increta, and percreta
Recognizing these indications is essential for managing severe obstetric complications.
What are the advantages of lower segment cesarean section (LSCS) over upper segment cesarean section (USCS)?
- Stronger scar
- Better healing
- Less hematoma
- Less hemorrhage
- Less infection
- Less abdominal distension and ileus
- Less adhesions and intestinal obstruction
- Lower mortality rate
The advantages of LSCS make it the preferred method in many cases.
