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N113 Operative Ob

N113 - Operative Obstetrics

QuestionAnswer
External Version Alteration to fetal position by external manipulation, after 37 wks. Normally only attempted once.
External Version procedure Baseline vitals, FHR, non-stress test, ultrasound to confirm position, IV or subq injection of terbutaline to relax uterus.
Internal Version Mostly done during delivery of twins
Forceps Used to rotate the fetus
Low/outlet forceps head on perineum, used to extend head
Mid forceps Heat a level of ischial spins, used to rotate head from LOA or ROA to anterior/posterior - anesthesia needed
Forceps - must knows... Presenting part of fetus, ruptured membranes, complete dilation, NO CPD - pelvic disproportion.
Forceps uses Fetal distress, maternal cardiac condition, maternal exhaustion
Forceps risks/assessments Bleeding, uterine & bladder tears, rectal fistulas, infection
Forceps - neonatal risks Ecchymosis or facial edema, transient facial paralysis, caput succedaneum (swelling that crosses the midline), cephalhematoma (swelling that doesn't cross midline)
Vacuum Head must be visable, suction cup is applied to presenting part & gentle traction is extended while mother pushes
Vacuum risks cephalhematoma, scalp laceration, subdural hematoma - severe risk, limited to certain # of 'pop offs'.
Cesarean Section Oldest surgical procedure.
Cesarean section indications Breech, fetal distress, dystocia, uteroplacental insufficiency, dysfunctional labor, CPD, herpes breakout
Almost always delivered C-section Prolapsed cord, placenta previa, placenta abruptio, herpes breakout
Created by: jrb265
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