Tuesday, 2-28-Operative delivery (Wootton) Flashcards Preview

Repro 2-Final > Tuesday, 2-28-Operative delivery (Wootton) > Flashcards

Flashcards in Tuesday, 2-28-Operative delivery (Wootton) Deck (20):
1

options for vaginal operative delivery?

forceps-assisted and vacuum-extract

2

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

3

fetal indications for operative vag delivery?

non-reassuring fetal status (bradycardia, repetitive heart rate decelerations)

4

fetal criteria/pre-reqs for operative vag delivery?

-vertex presentations
-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

5

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)

Low

6

this forceps operative vag delivery is when the fetal skull is above +2 station, not ever indicated today

midpelvis and high forceps

7

Best position for baby head during station? Ok position?

best--> occipito-anterior (preferably straight)
ok --> occipito-posterior

8

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

9

maternal complications of forceps delivery?

-laceration of vagina/cervix
-episiostomy extension
-pelvic hematomas
-urethral and bladder injuries
-uterine rupture

10

fetal complications of forceps delivery?

-minor facial lacerations
-forceps marks
-facial and brachial plexus injuries
-cephalohematomas
-skull fractures
-intracranial hemorrhage
-seizures

11

indications for vacuum-assisted bag delivery? advantage of vacuum-assisted?

-EXACTLY THE SAME AS FORCEPS

-advantage: Delivery can be achieved with little maternal analgesia

12

contraindications to vacuum assisted vag delivery?

-gestational age < 34 wks
-suspected fetal coag disorder
-suspected fetal macrosomia
-breech presentation

13

correct cup placement and position for vacuum-assisted vag delivery?

Flexing median

posterior fontanelle

14

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

15

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

16

fetal indications for C section?

-non reassuring fetal heart rate
-breech presentation/transverse presentation
-very low birth weight (<1500 gm)
-active HSV infx
-ITP
-congenital anomalies (gastroschisis, spina bifida)

17

maternal-fetal indications for C section?

-cephalopelvic disproportion
-failure to progress
-placental abruption
-placenta previa

18

maternal indications for C section?

-obstructive benign and malignant tumors
-large vulvar condyloma
-abdominal cervical cerclage
-prior vag colporrhaphy
-conjoined twins
-maternal request?

19

C-section intraoperative complications?

-uterine a. lacerations
-bladder injuries
-ureteral injuries
-GI tract injury
-uterine atony
-placenta accreta
-Caesarean hysterectomy

20

post-op complications of C sections?

-endomyometritis (infx of uterus)
-wound complications --> infx, separation, dehiscence
-urinary complications (retention, infx,)
-Gi complications (ileus, diarrhea)
-Thromboembolic disorders (PE/DVT)
-septic pelvic thrombophlebitis (infx blood clot of most commonly ovarian v.)