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CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) > OPERATIVE OBSTETRICS PART 2 > Flashcards

OPERATIVE OBSTETRICS PART 2 Flashcards

1
Q
  • aka instrumental delivery or operative vaginal delivery
  • an instrument is used to assist in th ebirth of the fetal head
A

forceps-assisted birth

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2
Q

categories of forceps application

A

outlet
low
mid

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3
Q

are applied when fetal skull reached the perineum, fetal scalp is visible, sagittal suture not more than 45 degrees from the midline

A

outlet forceps

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4
Q

what forceps? fetal position - occiput anterior or posteriori left or right

A

outlet forceps

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5
Q

are applied when leaing edge (presenting part) of fetal skull is at a station of 2+ or more

A

low forceps

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6
Q
  • are applied when the fetal head is engaged
  • station is above +2 but not higher than station 0
A

mid forceps

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7
Q

maternal indications of forceps assisted birth

A
  • heart disease
  • pulmonary edema
  • infection
  • exhaustion
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8
Q

fetal indications for forceps assisted birth

A
  • premature placental separation
  • nonreassuring fetal status
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9
Q

pre requisites for foeceps assisted birth

A
  • completely dilated
  • ruptured membrane
  • engaged head
  • empty bladder, adequate anesthesia
  • no CPD
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10
Q

neonatal risks of forceps assisted birth

  • E___
  • E___
  • C___ S___ or C___
  • F___ L____
  • T____ F___ P____
  • C___ H____
A

ecchymosis
edema
caput succedaneum / cephalhematoma
facial lacerations
transient facial paralysis
cerebral hemorrhage

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11
Q

maternal risks of forceps assisted birth

A
  • lacerations
  • episiotomy to anus
  • bleeding
  • perineal edema
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12
Q
  • an obstetric procedure used to facilitate the birth of the fetus by applying suction to the fetal head
  • gentler alternative to forceps
A

vacuum assisted birth

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13
Q

the vacuum extractor is composed of a ___ attached to a suction bottle by tubing

A

soft suction cup

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14
Q

the suction cup is placed against the ___ and the pump is used to create a negative pressure inside the cup

A

fetal occiput

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15
Q

pre-requisites for vacuum assisted birth

A
  • completely dilated
  • ruptured membranes
  • engaged head
  • vertex presentation
  • no CPD
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16
Q

in vaccum assisted, ther should be progressive descent with the first ___ pulls

A

two

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17
Q

vacuum procedure should be limited to prevent ___

A

cephalhematoma

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18
Q

the risk of cephalhematoma generally increases if the birth does not occur within ___ minutes

A

6

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19
Q

newborn risks for vacuum assisted birth

A

cephalhematoma
scalp lacerations
subdural hematoma
jaundice

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20
Q

maternal risks for vacuum assisted birth

A

perineal/vaginal/cervical lacerations
soft tissue hematomas

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21
Q

the parents need to be reassured that the caput on the baby’s head will disappear within ___ days

A

2-3

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22
Q
  • the birth of the fetus through abdominal and uterine incision
  • oldest surgical procedures known
A

cesarean birth

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23
Q
  • to preserve the life or health of the mother and her fetus
  • may be the best choice for birth when evidence exists of maternal or fetal complications
A

cesarean birth

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24
Q

initially CS made up only 5% of births, but during the late 1980s it gradually rose to about ___

A

25%

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25
in 2013, the CS rate had risen to ___
32%
26
factors contributing the increasing US CS birth rate
- macrosomia - advanced age - obseity / GDM - multifetal - dystocia - decline in VBACs and TOLACs
27
true or false - vaginal birth has a higher maternal mortality rate than CS births
false
28
approximatety ___ per 100,000 women die during a vaginal birth
2.1
29
approx. ___ per 100,000 women die after undergoing a CS birth
5.9
30
CS birth incidence of death - ___ per 100,000
19.2
31
common associations of perinatal morbidity
- infection r/t anesthesia - blood clots - bleeding
32
C/I for CS birth
- fetal death - fetus is too immature to survive - maternal coagulation defects
33
types of CS birth
- scheduled / elective - emergency
34
potential risks of CS on request
- longer hosp stay - risk of respi problem for baby - uterine rupture - placental implantation problems
35
CS birth should not be perfomed unless a ges age of ___ has ben accurately determined
39 weeks
36
uterine incisions
low transverse vertical (low / classic)
37
made across lowest and narrowest part of the abdomen
transverse
38
made between navel and symphysis pubis
vertical
39
- does not allow for an extension of an incision if needed - ised when time is not of the essence - required more time to make and repair
transverse
40
preferred unless without complications (very large fetus or placenta previa in the lower anterior uterus)
low transverse / low segment
41
reasons for use of low transverse incision
- thinnest portion - less blood loss - moderate dissection of the bladder - easier to repair - less likely to rupture - decreased chance of adherence of bowel to the incision - VBAC is possible
42
disadvanatges of low transverse incision
- takes longer - limited in size - greater tendency to extend laterally - incision may stretch
43
- quicker and is therefor preferred in cases of nonreassuring fetal status - preterm or macrosomic baby - obese
vertal incision
44
preferred for multiple gestation, abnrmal presentation, placenta previa, nonreassuring fetal status and preterm and macroomic fetuses
low vertical incision
45
diadvatages of low vertical
- extend downward - more extensive dissection of bladder - closure is more difficult - higher risk of rupture - subsequent births need to be CS
46
- method of choice for many years but is used infrequently now - vertical incision was made into the upper uterine segment
classic incision
47
- more blood loss and more difficult to repair - increased risk of uterine rupture with usbsequent pregnancy, labor and birth
classic incision
48
maternal complication of classic incision
- aspiration - hemorrhage - atelectasis - endometritis - abdominal wound dehiscence - UTI - bladder/bowel injury
49
fetus complications of classic incision
- asphyxia - injuries caused by scalpel - longer recovery
50
delayed ___ to rpomote eye contact between parent and infant in the 1st hour after birth
installation of eye drops
51
CS birth should - ___ after midnight
NPO
52
give preop meds - ___ may be administered within 30 mins of surgery
antacids
53
after CS birth mother should ___ after 12 hours
ambulate
54
most common complication after CS birth
pelvic thrombosis (blood clot in pelvic vein)
55
- the women undergoes a trial of labor in cases of nonrecurring indications for a CS - influenced by a consumer demand that this was a viable alternative to repeat CS
VBAC - vaginal birth after cesarean
56
overall success rate is approx ___
60 to 80%
57
benefits of VBAC
- avoid major abdominal surgery - lower rates hemorrhage, infection - shorter recovery period - avoid hysterectomy, bowel/bladder injury, transfusion, infection, and abnormal placentation
58
potential harms of VBAC
- hemorrhage - infection - operative injury - thrombolembolism - hysterectomy - death
59
a failed ___ is associated with more complications than elective repeat CS delivery
TOLAC - trial of labor after cesarean
60
___ is higher in the setting of a failed TOLAC than in VBAC
neonatal morbidity
61
C/I for VBAC
- previous t-shaped incision - previous extensive transfundal uterine surgery - vaginal delivery is contraindicated
62
VBAC - generally a ___ is inserted for IV access if needed or an IVF is started
saline lock

CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) (55 decks)

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