Flashcards in Tuesday, 2-28-Operative delivery (Wootton) Deck (20):
options for vaginal operative delivery?
forceps-assisted and vacuum-extract
maternal indications for operative vag delivery?
-maternal exhaustion/lack of expulsive effort
-inability to have expulsive effort --> SC injuries, NM disorders
-need to avoid maternal expulsive efforts --> cardiac conditions (i.e., aortic stenosis) and cerebrovascular disease
fetal indications for operative vag delivery?
non-reassuring fetal status (bradycardia, repetitive heart rate decelerations)
fetal criteria/pre-reqs for operative vag delivery?
-fetal head must be engaged (biparietal diameter at 0 station)
-position of fetal head must be known WITH CERTAINTY
-station of fetal head must be > +2
this forceps operative vag delivery method is when the leading point of fetal head is at +2 station or more and is not on the pelvic floor (can be rotational or non-rotational)
this forceps operative vag delivery is when the fetal skull is above +2 station, not ever indicated today
midpelvis and high forceps
Best position for baby head during station? Ok position?
best--> occipito-anterior (preferably straight)
ok --> occipito-posterior
when do you NOT apply forceps delivery?
-If you aren't positive of position
-if they don't articulate easily you re-apply but if they still don't articulate well --> Don't apply
maternal complications of forceps delivery?
-laceration of vagina/cervix
-urethral and bladder injuries
fetal complications of forceps delivery?
-minor facial lacerations
-facial and brachial plexus injuries
indications for vacuum-assisted bag delivery? advantage of vacuum-assisted?
-EXACTLY THE SAME AS FORCEPS
-advantage: Delivery can be achieved with little maternal analgesia
contraindications to vacuum assisted vag delivery?
-gestational age < 34 wks
-suspected fetal coag disorder
-suspected fetal macrosomia
correct cup placement and position for vacuum-assisted vag delivery?
what 3 checks should be undertaken before use of vacuum-extraction?
-no maternal tissue trapped in cup
-cup should be placed in midline of saggital suture
-vacuum port of suction cup should point toward occiput
vacuum extractor complications?
compared to forceps:
-more failed deliveries with vacuums (failure rate of 12% for vacuum vs 7% for forceps)
-fewer perineal injuries
-increased incidence of fetal cephalohematoma
-more scalp lacerations and bruising
fetal indications for C section?
-non reassuring fetal heart rate
-breech presentation/transverse presentation
-very low birth weight (<1500 gm)
-active HSV infx
-congenital anomalies (gastroschisis, spina bifida)
maternal-fetal indications for C section?
-failure to progress
maternal indications for C section?
-obstructive benign and malignant tumors
-large vulvar condyloma
-abdominal cervical cerclage
-prior vag colporrhaphy
C-section intraoperative complications?
-uterine a. lacerations
-GI tract injury