Obstetric Procedures and Operative Delivery
Core concepts
This domain covers cesarean delivery indications and technique, operative vaginal delivery, episiotomy, and procedures such as cerclage, external cephalic version, and amniotomy. Know absolute and relative cesarean indications (placenta previa, prior classical cesarean, malpresentation, arrest disorders, nonreassuring fetal status). Understand the difference between low transverse and classical uterine incisions and implications for future trial of labor. External cephalic version is offered for breech presentation near term with contraindications (placenta previa, ruptured membranes, nonreassuring fetal status). Cerclage is considered for cervical insufficiency. Forceps and vacuum have specific prerequisites and complication profiles (vacuum: cephalohematoma, retinal hemorrhage; forceps: facial nerve injury).
Traps
A common trap is recommending trial of labor after a classical or T-incision - these require repeat cesarean. Another is performing version without confirming fetal wellbeing and absence of contraindications. Questions may also test that episiotomy is not routine and is reserved for specific indications.
Rule of thumb
Before any operative delivery, confirm indication, prerequisites, and consent; for version, confirm gestational age, presentation, and no contraindications.