What are the nerve roots involved in Stage I and Stage II of labor?
Stage I - T10-12
Stage II - S2-S4 - pudendal nerve
What is the most commonly used anesthesia in US?
At which stage of labor are narcotics used?
Active phase of stage I.
Do not give if multi is 8 cm dilated or primi is 10 cm dilated. It is because we do not want to have the sedative effect of narcotics when the baby is born because baby has to take its first breath after its delivery.
[Note: Pudendal nerve block is given in second stage of labor]
What is the most common side effect of Paracervical Block?
Transitory Fetal Bradycardia.
Management is conservative. Just wait and the Heart rate comes to normal.
[Note: Anesthesia is injected in Frankenhauser's ganglion on either side of cervix.]
(LUNA - Laparoscopic Uterine Nerve Ablation)
Classify forceps based on fetal head position?
Outlet forcep – fetal head on pelvic floor
Low – below +2 station but not reached pelvic floor
Mid - Below 0 station, but not reached +2 station
High – is unengaged, above 0 station
What is the most common indication for use of Obstetric Forceps and Vacuum?
Prolonged second stage
What are the advantages of Ventouse over forceps?
It can be used in unrotated and malrotated occipito-posterior position [IOM 2061] of the head.
It can be applied even through incompletely dilated cervix. (1st stage of labor)[UP 94]
It is not a space occupying device like forceps blades.
Lesser traction force is needed.
What is cephalohematoma?
- Collection of blood in between the pericranium and the flat bone of the skull, usually unilateral and over parietal bone.
-It is never present at birth but gradually develops after 12-24 hours. [AI 92]
- The swelling is limited by the suture lines of the skull.
- It is soft, fluctuant, and imcompressible.
- The swelling reabsorbs slowly within 2-12 weeks of birth, depending on their size.
What is caput succedaneum?
Caput succedaneum is a diffuse edema of the fetal scalp that crosses the suture lines.
Head compression against the cervix impedes venous return, forcing serum into the interstitial tissues.
The swelling reabsorbs within 1-3 days.
What is the difference between Caput succedaceum and cephalohematoma?
Caput succedaceum - above periosteum, crosses midline.
Cepahlohematoma – below periosteum, [since it is below the bone, it is limited to periosteum and is limited to the bone, thus, doesnot cross the midline]
What is subgaleal bleeding?
Subgaleal hemorrhage or hematoma is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.
90% of hemorrhage is because of vacuum delivery.
[Note: Going from outer to inner we get --
Caput - Subgaleal hemorrhage - Cephhalhematoma]
What is External Cephalic Version? When is it done?
External cephalic version is a procedure to turn the fetal presenting part from a non cephalic presentation to a cephalic presentation. Because cephalic version is performed by manipulating the fetus through the abdominal wall, the maneuver is known as external cephalic version.
Timing - It is done at 37 weeks. If it is done earlier, spontaneous turning is common. After 37 weeks, external cephalic version is difficult.
1. Breech presentation - successful version is likely in case of complete breech (flexed breech) that is unengaged.
2. Transverse lie/ Oblique lie - External version is much easier here than in breech presentation.
1. Antepartum hemorrhage- Placental previa or abruption
2. Fetal causes - congenital abnormalities, dead fetus