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Labor Stage 1: Obstetric Anesthesia

by Veronica Gillispie, MD, FACOG
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    Now let's discuss Operative Delivery. We'll start with the case presentation. A 25 year old gravida 1 para 0 female at 38 weeks gestation and 2 days presents to labor and delivery in active labor. She is not at stage 2 of labor. She has an epidural in place and has been pushing for 3 and a half hours. How would you manage her delivery at this point? Let's go through the lecture to find the answer. So operative deliveries have 3 types that we can do operatively. A vacuum assisted vaginal delivery. Forcep delivery and cesarean section. Let's take the time to talk about each of these in a bit of detail. So the indications for any operative vaginal delivery, fetal tolerance of labor. So we're talking about a category 3 tracing. Arrest of the 2nd stage of labor. And if you remember the 2nd stage of labor is when mom is pushing the baby out. And if we had no descent over 2 hours then we now have an arrest for second stage. And then shortening of second stage of labor. So there's some maternal conditions where we do not want mom to exert. The force that it takes to push such as cardiac anomalies, intercranial issues. In those cases we will perform an operative vaginal delivery so that mom doesn't have to exert that force. Now, there is a criteria to perform the operative delivery as well as those indications. First is knowledge of the fetal position. And when we speak of fetal position, we're talking about the fetal occiput in relationship to the maternal spine. So you can see from our examples here. Occipit anterior is what we most commonly see and that's what we have here at the top. But you can also have occiput...

    About the Lecture

    The lecture Labor Stage 1: Obstetric Anesthesia by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:

    • Obstetric Anesthesia
    • Regional Analgesia – Epidural and Spinal

    Included Quiz Questions

    1. Maternal nausea and lightheadedness
    2. Fetal respiratory depression
    3. Maternal hypotension
    4. Late decelerations on fetal heart tracing
    5. Uteroplacental insufficiency
    1. Uteroplacental insufficiency
    2. Postpartum hemorrhage
    3. Fetal respiratory depression
    4. Maternal nausea and vomiting
    5. Maternal aspiration pneumonia
    1. Injection of analgesia directly into the spinal fluid for regional analgesia used during cesarean sections
    2. Administration of a slow flow of analgesia via a catheter into the epidural space in the spine only used during cesarean sections
    3. Administration of a slow flow of analgesia via a catheter into the epidural space in the spine which can be used during normal labor or cesarean sections
    4. Administration of opiates into the pudendal nerve to create a local nerve block used in operative vaginal deliveries
    5. Injection of analgesia directly into the spinal fluid for regional analgesia used during normal labor

    Author of lecture Labor Stage 1: Obstetric Anesthesia

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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