Complications - operative obstetrics
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“Poverty is lot like childbirth – you know it is
going to hurt before it happens, but you’ll never
know how much until you experience it”
Joanne Kathleen Rowling
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A day in a labour Room……
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For successful vaginal
delivery….
Perineal massage and regular pelvic
floor exercises.
Perfect “P”s
Changes in maternal positioning
Reduction in neuraxial anesthesia
Increased emotional support
Laboring down
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Operative Delivery
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Traction
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Incidence
(Birth 2002)
%
1980
1990
2000
Forceps
17.7
8.6
4.0
Vacuum
0.7
6.1
8.4
Caesarean
16.5
23.5
22.9
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Complications related to
Operative Obstetrics:
Nursing Challenge
Problems arising from
Episiotomy
Pain
Edema
Bleeding
Infection
Defects in wound closure
Sexual discomfort /dysfunction
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Complications of AVD - Maternal
Lacerations: Vaginal / perineal /
cervical
Hematoma / Haemorrhage
Incontinence / retention of urine
Infection
Painful perineal scars
Low back pain
Dyspareunia
SUI
Nerve Injury
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Neonatal Morbidity
Low Apgar scores
Scalp trauma
Facial mark/injury
Cephalhematoma
Subgaleal hematoma
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Chignon
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Cephalhematoma
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Cephalhematoma
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Subgaleal Hematoma
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Subgaleal Hematoma
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Neonatal Morbidity
Intracranial hemorrhage
Retinal hemorrhage
Neonatal jaundice
Erb palsy
Fractured clavicle
Nerve injury
Shoulder dystocia
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Birth Asphyxia & Injuries
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Cesarean delivery
complications
Bleeding
Atelectasis
Bladder injury
GIT injury
Ureter injury
Paralytic ileus
Wound infection
Wound dehiscence
UTI
Endometritis
Thrombophlebitis
DVT
Adhesions
Intestinal Obstruction
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Cesarean Section
Complications
University hospital,
Glostrup
– 7782 women
– c/sec rate: 929 (11.9%)
– Emergency c/sec rate :
636(68.5%)
Acta Obstet Gynecol Scand 2003 : 82: 251-256
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Incidence of Intraoperative
Complications
Type of complication
Cervical laceration
Total
3.6%(33)
Emergency
4.6%(29)
Elective
1.4%(4)
Corporal laceratoin
Vaginal laceration
Bladder laceration
0.3%(3)
1.2%(11)
0.5%(5)
0.3%(2)
1.7%(11)
0.8%(5)
0.3%(1)
0.0%(0)
0.0%(0)
Bowel laceration
Lacerations in total
Blood transfusion
EBL ≥ 1000ml
0.0%(0)
5.2%(48)
1.0%(9)
9.2%(77)
0.0%(0)
6.8%(43)
1.1%(7)
9.0%(57)
0.0%(0)
1.7%(5)
0.7%(2)
6.8%(20)
0.3%(3)
0.2%(2)
12.1%(112)
0.5%(3)
0.2%(1)
14.5%(92)
0.0%(0)
0.3%(1)
6.8%(20)
Uterine rupture
Hysterectomy
Total
Effect of Delivery on Neonatal
Injury
Delivery
Death
ICH
Other
NSVD
1/5,000
1/1,900
1/216
C/S in Labor
1/1,250
1/952
1/71
C/S w/o Labor
1/1,250
1/2,040
1/105
Vacuum
1/3,333
1/860
1/122
Forceps
1/2,000
1/664
1/76
Vacuum & Forceps
1/1,666
1/280
1/58
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Postpartum maternal
complications
Postpartum hemorrhage
Postpartum infections
Thrombophelebitis
Subinvolution
Mastitis
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Prevention is better
Experienced provider
Assessment of maternal pelvis
Selection of procedure
Adequate anesthesia
Fulfillment of prerequisites
Willingness to abandon attempt
Ability to perform c-section
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Some tips……
Center of the cup
over the sagittal
suture, about 2 cm
in front of the
posterior fontanel.
Metal cup
Soft cup
Release suction between Pushes
2 pop-offs, abandon procedure
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Vacuum Procedure
Check for vaginal or vulvar
tissues trap between the
cup and fetal surface.
Gradual Vs Rapid
Application of Vacuum
Pressure
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Fear during labour
Worries
Review labour process
Frequent progress report
Personal availability of nurse
Promise postnatal debriefing
sessions
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Nursing considerations
Availability
Organization
Calmness
Communication
Delegation
Consent
Preparation
Teamwork
Tackling failure
Be prepared,
except the
unexpected
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As a midwife…….
Confidence & Competence
Open mind, accepting attitude, hands-on
skills, and broad deep understanding
Surveillance of fetus and mother
Data acquisition: interpret data
Verbal and nonverbal cues
Patient-centered care - “high tech” and “high
touch”
Conducive environment and low stress
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Speak tenderly to them. Let there be kindness in
your face, in your eyes, in your smile, in the
warmth of our greeting. Always have a cheerful
smile. Don't only give your care, but give your
heart as well.
- Mother Teresa
THEY NEED YOU
& YOUR CARE
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