Operative Vaginal Delivery and Cesarean Section PDF

Operative Vaginal Delivery: Caesarean Section Vacuum Extraction And Forcep Delivery :Deliveries that require assistance in delivering baby; dysfunction of 5 Ps OVD: Indications -​ Prolonged second stage of labor -​ Ineffective maternal pushing -​ Excessive regional a...

Operative Vaginal Delivery: Caesarean Section Vacuum Extraction And Forcep Delivery :Deliveries that require assistance in delivering baby; dysfunction of 5 Ps OVD: Indications -​ Prolonged second stage of labor -​ Ineffective maternal pushing -​ Excessive regional anesthesia -​ Delayed or arrested second stage of labor -​ Fetal distress -​ Maternal compromise OVD: Requirements -​ Maternal consent -​ Skilled physician -​ Adequate anesthesia -​ Ability to perform cesarean prn -​ Fully dilated cervix -​ Engaged fetal head -​ Empty maternal bladder Vacuum Extraction -​ Soft suction cup is applied to fetal occiput -​ Suction with each contraction -​ Fewer maternal side effects -​ May cause subgaleal hematoma, scalp lacerations in fetus -​ Follow protocols carefully! -​ Increased risk of perineal tear Forceps Assisted Birth -​ Metal blades shaped to fit on either side of fetal head -​ Blades are then interlocked and gentle traction is applied -​ May be used for rotation and descent -​ Increased risk of maternal injury -​ No hard pressure; can cause nerve damage -​ Increased risk of perineal tear -​ Increased risk of infection= Prophylactic antibiotics Risks of Cesarean Birth IMMEDIATE: LONG TERM: -​ Less early contact with newborn -​ Poor overall mental health and self esteem -​ Emergency hysterectomy -​ Chronic pain and bowel obstruction -​ Thromboembolism and CVA -​ Readmission -​ Surgical injury -​ Pain -​ Hemorrhage -​ Adhesions -​ Infection -​ Abnormal placentation with future pregnancy -​ Incidental surgical injuries -​ Uterine rupture with future pregnancy -​ Extended hospitalization Risks for Newborn -​ Neonatal death -​ Respiratory difficulties: TTN and RDS (no crying; place on tummy to drain fluid) -​ Asthma in childhood and adulthood -​ Iatrogenic prematurity -​ Surgical injuries -​ Failure to breastfeed *Cesarean Birth: Indications Maternal: Maternal request -​ CPD -​ Fetal: -​ Active infection -​ Non-reassuring fetal status* -​ Previous cesarean* -​ Abnormal lie/presentation* -​ Failure to progress* -​ Macrosomia -​ Placenta previa -​ Multiple gestation -​ Cord prolapse Cesarean Birth: Classical -​ Vertical incision through uterus -​ More rapid birth achieved -​ More likely to rupture in subsequent pregnancy Low Transverse: -​ Future TOL (trial of labor)/VBAC (Vaginal birth after c-section) -​ Less blood loss -​ Less likelihood of GI complications and infection postpartum Preoperative Care Post Op Care -​ Teaching essential -​ Assess ABCs -​ Informed consent (by doctor) -​ Vital signs q 15 min x 1-2 hours -​ Hair clip (no shaving) -​ Temp hourly and prn -​ IV, pre-op labs -​ Assess incision, fundus, vaginal bleeding -​ Pre-op meds with vital signs -​ Jewelry/metal removal -​ I&O -​ Foley -​ N/V -​ SCDs or TED hose -​ SCDs or TED hose -​ Support person present -​ Pain: assess and treat -​ Facilitate bonding and breastfeeding VBAC May be attempted if: -​ Fetus is vertex -​ Fetus is not macrosomic -​ Original reason for C/S is not present in current pregnancy -​ Woman is healthy Risks: -​ Uterine rupture -​ Complications of vaginal birth Contraindications: -​ 2 previous C/S without ever having delivered vaginally -​ 3 previous C/S -​ Any scarring above the lower uterine segment, uterine anomalies -​ Previous uterine rupture Not Recommended if: -​ Multiple pregnancy -​ Maternal DM or HTN