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Second Stage Interve
Labour
Question | Answer |
---|---|
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 |