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Second Stage Interve


Forms of second stage intervention Episiotomy, forceps , vacuum extraction
Foetal indications for second stage intervention Foetal distress, shoulder dystocia, delivery of after coming head in breech
Maternal indications for second stage intervention Prolonged second stage, occipitoposterior position, maternal exhaustion, maternal comorbidities ex heart disease, epidural anaesthesia (in some cases)
Prolonged second stage for nulliparous 2 hours sans epi, 3 hours with epi
Prolonged second stage for multiparous 1 hours sans epi, 2 hours with epi
Define episiotomy surgical incision on perineum inclusive of posterior vaginal wall
Episiotomy indications 1. prophylaxis of significant laceration 2. macrosomic delivery 3. rigid perineal muscles 4. instrumental delivery esp forceps, 4. foetal distress 5. moderate to severe shoulder dystocia
Types of episiotomy Median, mediolateral, J-shaped, lateral
Advantages of median episiotomy 1. Less painful 2. Reduced blood loss 3. Better healing 4. Less dyspareunia
Disadvantage of median episiotomy Tear may extend to involve anal sphincters leading to faecal incontinence
Advantage of mediolateral episiotomy Less risk of damage to anal muscle
Disadvantage of mediolateral episiotomy 1. greater blood loss 2. slow healing 3. more painful 4. dyspareunia
Materials needed for episiotomy Antiseptic solution, lidocaine or other LA, surgical scissors
steps of episiotomy part 1 1. Clean with antiseptic 2. Anaesthetise with 10mL 1% lidocaine (vaginal mucosa, skin of perineum, perineal muscle) 3. Position surgical scissors in midline of posterior fourchette aiming blade postero-laterally at 45 degrees
Steps of episiotomy part 2 4. When neonates head crowns & stretches perineum prepare to cut 5. Protect baby's head 6. Cut at height of contraction.
Suture used in episiotomy repair 2-0 round body absorbable Vicryl sutures
Describe repair of episiotomy P1 1. Perineal muscle closed first (interrupted sutures) 2. Vaginal mucosa closed next (continuous sutures) 3. Perineal skin sutures (interrupted, cutting edge)
In what direction do you do an episiotomy repair? Start at apex (1cm above) and suture to level of hymenal rings
How would you advise a patient to care for her episiotomy? P1 1. Sitz bath twice a day and subsequent to passing stool 2. NSAID first week after delivery 3. Take antibiotics as prescribed
Care of episiotomy P2 4. No sex until cleared by OBGYN at 6 week clinic 5. Prevent constipation with high fibre diet and fluids 6. Return if note the following emergencies
When would you advise a patient who just received an episiotomy to seek medical attention? 1. Persistent/worsening swelling 2. Persistent/worsening pain 3. Foul smelling discharge 4. Increased bleeding 5. Loosened sutures/reopening of area
Prerequisites for forceps delivery 1. Experienced operator 2. Informed consent 3. Presentation: cephalic 4. Cervix: Fully dilated 5. Membranes: ruptured 6. Bladder: empty by ucath 7. Station: +2 or lower 8. Position of head: known 9. LA and episiotomy
Which is preferred, forceps or vaccuum? Vacuum
Prerequisites for vacuum delivery 1. Experienced operator 2. Informed consent 3. Presentation: cephalic 4. Cervix: 8cm dilated at least 5. Membranes ruptures 6. Bladder emptied 7. Station +1/+2 8. Position of head known 9. LA. Episiotomy optional
Created by: IonaDel