OB Delivery

Anesthesia

• Benefits: Opiates (anytime)
  
  • Epidural
    
  • Paracervical block
    
  • Pudendal nerve block
    
• Risks:
  
  • Prolonged latent phase … baby needs naloxone
    
  • Tocometer, pushing coach…hypotension/ death
    
  • Stage I: dilation… fetal bradycardia
    
  • Stage II: Delivery… miss

Cerclage

• Benefit: Incompetent cervix (caused by PID, repeat STI or repeat D&C) => 2nd trimester loss
  
• Risk: Wk 14 insertion => ROM
  
• Wk 36 removal => cerval rupture

C-section

• Benefits:
  
• 1) elective
  
  • – breach
    
  • – desired
    
• 2) Urgent
  
  • – prolonged labor
    
  • – arrest of labor
    
  • – exxlampsia
    
• 3) Emergent
  
  • – Hemodynamic instability
    
  • – Fetal distress
    
• Risk: VBAC, scar, permanent sterilization (bilateral tubal ligation)

Episotomy (lacerations)

• Benefits: Macosomic + 1st time moms
  
• Risk: Lacerations + Post partum hemorrhage
  
• Bonus: Laceration grading
  
  • – Grade I = vagina only
    
  • – Grade II = perineal body
    
  • – Grade III = sphincter
    
  • – Grade IV = Mucosa

Vacuum + Forceps

• Benefits: Fetal distress/prolonged/ arrestof labor
  
• + full effacement, + 2+ station,
  
• Risk: Denuding vagina, cephalohematoma, bell’s palsy