University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

207

Pages:

1
Author:

Pierre BERNARD

Operative delivery Instrumental Delivery Indications 2nd stage delay (but not due to poor uterine activity) Suspected fetal compromise in 2nd stage Maternal condition requires short 2nd stage Conditions Full dilatation - Cervix must be fully dilated Occiput – know where it is + Head at/below spines, no head palpable abdominally ROM Catheterise Episiotomy Pain relief satisfactory Forceps Low/mid cavity forceps (non rotational) Mother in lithotomy position with bottom over edge of bed Perineum cleaned and draped, bladder emptied and VE rechecked Analgesia applied if not already (pudendal block & perineal infiltration) Episotomy usually required Rotational forceps (Kiellands) Should only be used by experienced physicians Rules Always episiotomy (lateral midline) Analgesia Descent with each pull Complications Haemorrhage Perineal trauma Fetal scalp trauma (not as much as ventous) Cephaloheamatoma / subaponeurotic haemorrhage / intracranial haemorrhage Ventouse Less pelvic space required Decreased analgesia required, decreased trauma More cephalohaematoma, increased failure rate, lower APGAR scores at 10mins Rules Descent with each pull (abandon if no movement in 3 pulls) Reapply cup no more than twice (unless senior involved) Complete delivery within 15 minutes of application Avoid 2nd instrument unless vertex on perineum Episiotomy not always required Caesarean Section Almost 21% of births Pre Labour - for placenta praevia, severe fetal growth restriction, transverse lie, breech, or large abruption In Labour – forceps/ventouse failure, cervix not fully dilated, mother unsuitable for vaginal delivery Risks to mother – infection, TED, haemorrhage (emergency section has higher mortality rate) Lower segment is preferable – as fewer complications and better outlook for future pregnancies Classic section is vertical incision, used for transverse lie, very vascular anterior placenta praevia, lower segment fibroids, or very preterm with SRM. Higher complication rate Preparation requires IV access, G&S, sodium citrate & ranitidine (to decrease mendelson’s syn = aspiration of gastric contents), thromboprophylaxis, antibotic prophylaxis, anaesthesia (spinal, epidural or general) & bladder catherisation