Medicine and surgery notes

Apr 24th, 2015
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INSTRUMENTAL DELIVERIESSALWA NEYAZICONSULTANT OBSTETRICIAN GYNECOLOGISTPEDIATRIC & ADOLESCENT GYNECOLOGISTVACUUM /VENTOUSEINDICATIONSMATERNALExhaustionProlonged second stageCardiac / pulmonary diseaseFETALFailure of the fetal head to rotateFetal distressShould not be used for preterm, face presentation orbreechMNEMONICA Anesthesia adequate appropriate positioning & accessB Bladder cathterizationC Cervix fully dilated / membranes rupturedD Determine position, station, pelvic adequacyE Equipment inspect vacuum cup, pump, tubing, check pressureMNEMONICF Fontanelle position the cup over the posterior fontan -ve pressure 10 cm H2O initially & between cont sweep finger around cup to clear maternal tissue pressure to 60 cm H2O with the next contractionG Gentle traction pull with contractions onlytraction in the axis of the birth canalask the mother to push during contMNEMONICH Halt halt traction if no progress with three tractionaided contractionsvacuum pops off three timespulling for 30 min without significant progressI Incision consider episiotomy if laceration imminentJ Jawremove vacuum when jaw is reachable ordelivery assuredCOMPLICATIONSVacuum assisted delivery is less traumatic to the mother &fetus than forcepsVentouse should be the instrument of choiceMaternal Vaginal laceration due to entrapme

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