37 Questions
What is one of the essential conditions for safe assisted vaginal birth?
Clear communication with healthcare personnel
What evidence level supports the reliability of ultrasound assessment for fetal head position prior to assisted vaginal birth?
Evidence level 4
According to RCOG Green-top Guideline No. 26, what is the recommendation regarding the routine use of abdominal or perineal ultrasound for assessing the fetal head during the second stage of labor?
Not recommended
In what situation may a low forceps be acceptable for assisted vaginal birth?
With suspected fetal bleeding disorders
What is a key aspect of safe assisted vaginal birth in terms of expertise?
Expertise in the chosen procedure
What should clinicians be aware of regarding ultrasound assessment prior to assisted vaginal birth?
'Gold standard' status of ultrasound assessment
Why should vacuum extraction be avoided in assisted vaginal birth?
Avoidance is not necessary
Who should perform assisted vaginal birth?
Operators with the necessary knowledge, skills, and experience
What training is recommended for obstetric trainees before performing assisted vaginal birth?
Competency in spontaneous vaginal birth
Why is training in vacuum and forceps birth important for obstetric trainees?
To receive appropriate training for assisted vaginal birth
What is a key contributor to adverse outcomes in assisted vaginal birth?
Inadequate training of healthcare providers
When should complex assisted vaginal births be performed?
Only by experienced operators or under their direct supervision
What is the goal of assisted vaginal birth?
To mimic spontaneous vaginal birth with minimal morbidity
Why is it important for operators to manage any complications during assisted vaginal birth?
To prevent adverse outcomes and ensure patient safety
What did the meta-analysis of nine studies comparing PCEA to continuous infusion show about obstetric outcomes?
They were comparable
In the RCT comparing PCEA with continuous epidural infusion, what was reported about the rates of normal birth?
Similar between PCEA and continuous infusion
What did the systematic review find regarding assisted vaginal birth when oxytocin was used at 6 cm dilatation onwards?
No impact on assisted vaginal birth rates
According to the NICE intrapartum care guideline, what is the recommendation about starting oxytocin in the second stage of labor for multiparous women?
It should not be started routinely
What did the meta-analysis report about the rates of uterine rupture in multiparous women where oxytocin had been commenced?
Higher rates of uterine rupture
In what stage of labor should oxytocin be used with caution according to the NICE intrapartum care guideline?
Second stage
What is recommended before considering oxytocin in the second stage of labor for a multiparous woman?
An assessment by an experienced obstetrician
What is a major risk associated with Caesarean birth in the second stage of labour compared to completed assisted vaginal birth?
Major obstetric haemorrhage
What is a potential consequence of using two instruments sequentially during delivery?
Higher risk of neonatal trauma
In a population-based retrospective analysis in the US, what was the reported risk associated with sequential use of vacuum and forceps compared to forceps alone?
Increased risk of needing mechanical ventilation
What is the risk of intracranial hemorrhage for births involving two instruments during delivery?
$1$ in $256$
What risk does Caesarean birth in the second stage of labour pose to the baby?
Increased admission to the neonatal unit
How does the risk of neonatal trauma compare between the use of two instruments and failed forceps proceeding to Caesarean birth?
Higher risk with two instruments
What is a potential consequence of a prolonged hospital stay related to Caesarean birth in the second stage of labour?
$1$ in $500$ risk of major obstetric hemorrhage
What does a population-based retrospective analysis report about the use of vacuum and forceps compared to forceps alone?
$2.22$ times increased risk of needing mechanical ventilation
What is a potential consequence of applying sequential instruments during delivery?
$2.5$ times increased need for mechanical ventilation
When should vacuum-assisted birth be discontinued?
Whenever there is no evidence of progressive descent with moderate traction during each pull.
What should experienced operators do if there is minimal descent with the first two pulls of a vacuum?
Evaluate the fetal position and cephalopelvic disproportion.
Which option is recommended for completing vacuum-assisted birth in the majority of cases?
Maximum of three pulls to bring the fetal head onto the perineum.
In what circumstances should less experienced operators stop a vacuum-assisted birth?
If there is minimal descent with the first two pulls of a vacuum.
What is the maximum number of pulls recommended for easing the head out of the perineum during vacuum-assisted birth?
Three additional gentle pulls.
Why is it important for experienced operators to stop and seek a second opinion during vacuum-assisted birth?
To check if they should change their approach or discontinue the procedure.
Which action indicates that vacuum-assisted birth should be discontinued?
'Pop-off' occurring after two pulls.
Test your knowledge on rotational births and vacuum-assisted births, including the instruments used and management of discontinued vacuum procedures. Be prepared to answer questions on when vacuum-assisted birth should be discontinued and how to manage a discontinued vacuum procedure.
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