An absolute contraindication for vaginal delivery for a patient who had a previous Cesarean section is:
Correct Answer A:
Vaginal birth after Cesarean (VBAC) is possible only if conditions are favorable. Absolute contraindication to VBAC include a prior low vertical uterine incision.
The medical and obstetrical benefits of successful vaginal delivery after Cesarean delivery derive from avoidance of the risks associated with repeat cesarean delivery, and especially multiple cesarean deliveries. The highest rate of maternal and neonatal morbidity occurs with uterine rupture, which can be fatal.
Contraindications to vaginal delivery include each of the following, except:
Correct Answer B:
Contraindications to vaginal delivery include footling breech, hyperextended fetal head, inadequate pelvic size, medical/obstetric contraindications to labour and vaginal delivery, abnormal fetus, previous classical Cesarean (classical uterine incision - vertical), total placenta previa, transverse lie presentation, untreated HIV infection, and herpes simplex virus with active genital lesions or prodromal symptoms.
When repairing a perineal laceration after a vaginal delivery, which one of the following suture materials decreases both wound dehiscence and postpartum perineal pain?
Researches show that the use of 3-0 polyglactin 910 suture (choice A) material results in decreased wound dehiscence and less postpartum perineal pain compared with repair using natural and absorbable plain catgut (choice B) or chromic catgut (choice C). Furthermore, use of rapidly absorbed polyglactin 910 suture decreases the need for postpartum suture removal after repair of second-degree lacerations. Nonabsorbable sutures are not indicated for the repair of obstetric perineal lacerations. Nonabsorbable sutures are made of special silk (choice D) or the synthetics polypropylene (choice E), polyester or nylon.
A woman who is 28 weeks pregnant is seen on ultrasound as having placenta previa.
All of the following are common complications of this condition, except:
Placenta previa involves implantation of the placenta over the internal cervical os. Variants include complete implantation over the os (complete placenta previa), a placental edge partially covering the os (partial placenta previa) or the placenta approaching the border of the os (marginal placenta previa). A low-lying placenta implants in the caudad one half to one third of the uterus or within 2-3 cm from the os.
Complications:
Prognosis:
Fifty percent of women with placenta previa have preterm delivery.
Those cases complicated with vaginal bleeding and extreme prematurity are at an increased risk of perinatal death. A greater incidence of fetal malformations and growth restriction is noted with placenta previa. An increased risk of neurodevelopmental delay and sudden infant death syndrome (SIDS) is associated with placenta previa.
Neonates are also more likely to have low birth weight (<2500 g), respiratory distress syndrome, jaundice, NICU admissions, and longer hospital stay.
A female patient develops a cystocele and procidentia (uterine prolapse).
What is the most appropriate treatment?
A cystocele (bladder prolapse) occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. A procidentia (uterine prolapse) is illustrated below.
All these defects can be repaired and treated via a vaginal hysterectomy. During surgery, all pelvic support defects should be corrected. Minimal defects that are not repaired are likely to worsen.
Click to expand