Operative Delivery - Wootton Flashcards
26, G1, 40 4/7 weeks gestation is in L&D w/ rupture of membranes. GDM and LSIL pap. Has been pushing for 3 hours.
a
32 G2P1 at 38 1/7, L&D w/ complaints of contractions. Asthma, had cholecystectomy after last baby. Cervix has not changed for last 6 hours despite adequate contractions.
a
2 types of non-spontaneous delivery
Vaginal (forceps or vacuum)
C-section
Forceps and vacuum extractor deliveries require what backup?
C-section if it fails
Maternal indications for forceps or vacuum? (3 groups)
- Maternal exhaustion
- Can’t have expulsive effort (neuro issues)
- Must avoid expulsive effort (aortic stenosis, CVD, etc.)
Fetal implication for operative vaginal delivery
Non-reassuring fetal status (bradycardia, heart rate decelerations, etc.)
Maternal criteria for operative vaginal delivery (4)
Analgesia, lithotomy position, empty bladder, consent
Fetal criteria for operative vaginal delivery (4)
Vertex presentation, fetal head must be engaged, fetal head position must be known, station of head must be > +2
Uteroplacental criteria for operative vaginal delivery (3)
- Fully dilated cervix
- Membranes ruptured
- No placenta previa
Using forceps requires baby position to be what?
No more than 45º rotated from a straight OA/OP axis
Contraindications to vacuum delivery (4)
- Less than 34 weeks
- Suspected fetal coag. disorder
- Suspected macrosomia
- Breech presentation
Increased risks in vacuum compared to forceps
- Failed deliveries
- Cephalohematomas
- Scalp lacerations and bruising
Decreased incidence in vacuum compared to forceps
Perineal injuries
Fetal indications for C-section
- Not good heart rate
- Breech/transverse
- Very light
- Active HSV infection
- ITP
- Congenital anomalies (gastroschisis, spina bifida)
Maternal/placental indications for C-section
- Placental abruption
- Placenta previa
