obstetrics_4.3_instrumental delivery

prerequisites (hx, pe)

indications (hx, pe)

contradications

forceps

vacuum extraction

forceps

vacuum extraction

vacuum: complications

forceps: complications

fetal head

outlet

low-cavity

mid-cavity

(high: not engaged)

above or equal to 2+

below 2+

perineum

fetal distress

(HCV, HIV, primary active genital herpes) maternal infection MOTHER

(full cervical dilation) (head x palpable: 1/5 or below) (station 0 or below)

smaller than 34 weeks NO

smaller than 34 weeks YES

BABY skrull fracture

facial nerve palsy, bruising

episiotomy

materal

conditions

(nulliparity >1 hour) (mulliparity > 2 hour) prolonged second stage of labour

cord prolapse v alive v fully dilated

vaginal breech delivery

(HT/PET, heart failure class III class IV, liver cirrhosis with esophageal varices) avoid maternal exhaustion

(myasthenia gravis) neurological

maternal exhaustion

abnormal scalp pH

meconium-stained liquor

abnormal fetal heart rate tracing

cephalo-pelvic disproportion BABY

coagulopathy BABY

(know head position) (ruptured membrane)

(patient consent) (local anaesthesia) (catheterize bladder)

face presentation NO

ITP NO

face presentation YES

(no rotational forcep delivery) DOA, DOP YES


direct occipito-anterior, direct occipito-posterior

MOTHER post-partum hemorrhage

MOTHER genital tract injury (anal sphincter tear, perineal tear, cervical laceration)

MOTHER genital tract injury (anal sphincter tear, perineal tear, cervical laceration)

MOTHER post-partum hemorrhage

BABY skrull fracture

cephalohematoma, subgaleal hematoma, intracranial hemorrhage

(1) OA上下 / OP前後 vacuum cup, vacuum tubing, vacuum machine, (2) flexion point: 3 cm posterior to anterior fontanelle, (3) no maternal tissue trapped

(indictions, contraindications, prerequisites: consent, analgesia, bladder)

(1) 60 cmHg, (2) pull when uterine contraction, (3) max 5 save some for senior

cord arterial blood gas, documentation, debriefing (check chinon, perineal tear)

Caesarean section

  • lower segment
  • classical (uterine rupture)
    preterm
    placenta preia
    transverse lie

emergency: indications

  • fetal distress
  • labour
  • x induction of labour
  • intrauterine infection
  • severe pre-clampsia

elective: indications

  • uterine scar
  • contracted pelvis
  • cephalopelvic disproportion
  • malpresentation
  • macrosomia

  • IUGR


  • premature

  • placenta previa

  • transverse lie


  • twin presenting twin malpresentation

surgical risks


immediate

  • postpartum hemorrhage

middle

  • infection

late

  • urinary tract trauma fistula