Flashcards in OPERATIVE INTERVENTIONS IN LABOUR Deck (15)
What are the indications for an episiotomy?
Previous perineal reconstructive surgery
What is the commonly used type of episiotomy in the UK?
How many layers should be individually sutured post-episiotomy?
1. Vaginal skin
2. Perineal body
3. Perineal skin
Having sutured up an episiotomy what must you do?
Perform a vaginal examination and PR examination to check that no sutures have broached rectal mucosa as this can result in fistula.
What are the different degrees of perineal trauma?
1st degree: involves skin only
2nd degree: involves skin and perineal muscles only
3rd degree (a): includes partial tear (less than 50%) of external sphincter
3rd degree (b): includes partial tear (more than 50%) of external sphincter
3rd degree (c): includes internal sphincter
4th degree: involves rectal mucosa
What is the most commonly used type of ventouse tool for assisted vaginal delivery?
What are the indications for using a ventouse cup?
Maternal: delay in 2nd stage of labour due to maternal exhaustion
Fetal: abnormal CTG or slow progress in 2nd stage of due to fetal malposition
What are the criteria you must check are fulfilled before proceeding with any instrument assisted vaginal delivery (ventouse or forceps)?
Give adequate analgesia
Abdominal examination must show head is either 0/5 or 1/5 palpable, also need to estimate fetal size
Vaginal examination: cervix must be fully dilated, head must be either at or below ischial spine (2+ fetal position), you must know fetal position, note the presence of caput or moulding
Adequate maternal effort and regular contractions is necessary for a ventouse delivery
Bladder must be empty for forceps delivery
How long should ventouse assisted delivery take maximum?
What are the complications of ventouse assisted delivery?
Maternal: Genital tract trauma with risk of haemorrhage and/or infection
Fetal: Chignon (scalp oedema) or cephalohaematoma
What are the types of non-rotational or traction forceps used in delivery?
What are the type of rotational forceps used in delivery?
What are the maternal indications for using forceps to assist delivery?
Medical conditions complicating labour eg cardiovascular disease
Unconscious mother ie mother is unable to keep pushing
What are the fetal indications for using forceps to assist delivery?
Gestation less than 34 weeks
Known or suspected fetal bleeding disorder
After-coming head of a breech