Operative Vaginal Delivery - Creighton University

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Operative VaginalDistrict 1 ACOG MedicalStudent Teaching Module 2011 Indications Maternal Benefit Shorten the 2nd stage of.
labor decrease the amount of pushingIe maternal cardiac conditions Eisenmenger s pulmonary HTN or history of aneurysm stroke Concern for immediate potential fetalcompromise.
Ie Prolonged terminal bradycardia Prolonged 2nd stageNulliparous No progress for 3 hrs w epidural or 2hours w o epiduralMultiparous No progress for 2 hrs w epidural or 1 hr.
w o epidural Operative Vaginal Delivery Incidence 4 5 of vaginal deliveries Forceps deliveries 0 8 Vacuum deliveries 3 7 .
Success Rate 99 Reflects appropriate choice of candidates What Do I Need To Know BeforeAttempting an Operative Delivery Presentation.
Cephalic Breech Position i e occiputposterior sacrum anterior Lie longitudinal oblique transverse .
Station Presence of asyncliticism Clinical pelvimetry Anesthesia Contraindications.
GA 34 weeks contraindication forvacuum due to risk of fetal IVH Known bone demineralization condition e g osteogenesis imperfecta or bleedingdisorder ie VWD .
Fetal head unengaged Position of fetal head unknown Vacuum Assisted Vaginal Delivery Do not apply rockingmotion or torque only.
steady traction in theline of the birth canal Stop after three pop offs of vacuum 20minutes elapsed three.
pulls with no progress After determining position of the head A insert the cup into thevaginal vault ensuring that no maternal tissues are trapped by thecup B Apply the cup to the flexion point 3 cm in front of theposterior fontanel centering the sagittal suture C Pull during a.
contraction with a steady motion keeping the device at right anglesto the plane of the cup In occipitoposterior deliveries maintain theright angle if the fetal head rotates D Remove the cup when thefetal jaw is reachable Fetal Risks VAVD.
Designed to detach if traction is excessive butcan produce traction up to 50 lbs 5 incidence serious complications Scalp lacerations if torsion excessive Cephalohematoma limited to suture.
Subgleal hematoma crosses suture Intracranial retinal hemorrhage Hyperbilirubinemia jaundice Higher incidence ofcephalohematoma retinal.
hemorrhage jaundice compared to Type of Forceps Delivery Outlet forcepsScalp visible at introitus w o separating labiaFetal skull reached pelvic floor head at on perineum.
Sagittal suture in AP diameter or LOA ROA or posterior positionrotation does not exceed 45 Low forcepsLeading point of fetal skull at 2 not on pelvic floorRotation 45 or less LOA ROA to OA or LOP ROP to OP or rotation.
greater than 45 MidforcepsAbove 2 cm but head engaged High forcepsHead not engaged not included in ACOG classification.
Not recommended Forceps Assisted Vaginal Delivery Identify apply bladesPlace instrument infront of pelvis with tip.
pointing up pelviccurve forwardApply left blade guidedby right hand then rightblade with left hand.
Lock bladesShould articulate with Check for correct applicationSagittal suture in midline of shanksCannot place more than one fingertip.
between blade and fetal head Apply tractionSteady and intermittentDownward and then upwardRemove blades as fetus crowns.
Risks Forceps Maternal RisksPerineal Injury extension of episiotomy Vaginal and Cervical lacerationsPostpartum hemorrhage.
Fetal RisksIntracranial hemorrhageCephalic hematomaFacial Brachial palsyInjury to the soft tissues of face forehead.
Skull fracture Using both forceps and vacuum Highest risk for injury is for combinedforceps vacuum extraction or cesareandelivery after failed operative delivery.
The weight of available evidence isagainst multiple efforts with differentinstrumentsOperative Vaginal Delivery District 1 ACOG Medical Student Teaching Module 2011 Indications Maternal Benefit – Shorten the 2nd stage of labor, decrease the amount of pushing Ie: maternal cardiac conditions (Eisenmenger’s, pulmonary HTN) or history of aneurysm/stroke Concern for immediate/potential fetal compromise Ie: Prolonged terminal bradycardia Prolonged 2nd stage Nulliparous = No ...

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