Operative Obstetrics refers to the use of surgical or instrumental techniques during labor and delivery when normal vaginal delivery is not progressing safely for the mother or fetus.
👉 It includes procedures like episiotomy, forceps delivery, vacuum extraction, cesarean section, and in rare cases, destructive operations.
🔹 When labor is prolonged or arrested
🔹 When there is fetal distress (abnormal FHR, meconium-stained liquor)
🔹 When the fetus is in abnormal presentation (breech, face, transverse)
🔹 If there is cephalopelvic disproportion (CPD)
🔹 When mother is exhausted or has a medical condition (heart disease, hypertension)
🔹 When there is placenta previa or cord prolapse
🔹 In cases of previous cesarean section or uterine scar
✂️ A surgical cut on the perineum (area between the vagina and anus) to enlarge the vaginal opening during delivery.
🔸 Types:
• Mediolateral – most common, safe from anal tear
• Median – less pain, but risk of tearing to anal sphincter
🔸 Indications:
• Primigravida with rigid perineum
• Big baby
• Instrumental delivery
• Breech presentation
🔸 Post-op Care:
• Sitz bath
• Analgesics
• Inspection for infection or hematoma
• Encourage hygiene and ambulation
🔧 A metal instrument with two blades is inserted into the vagina to grip the baby’s head and assist in delivery during the second stage of labor.
🔸 Types:
• Low forceps
• Outlet forceps
🔸 Indications:
• Maternal exhaustion
• Fetal distress
• Inability to bear down due to spinal anesthesia
🔸 Complications:
• Vaginal/rectal injury
• Facial injury or skull fracture in neonate
🔸 Nursing Care:
• Monitor for maternal trauma
• Newborn assessment (especially cranial injury)
💨 A suction cup is applied to the baby’s scalp, and negative pressure is used to assist in delivery.
🔸 Indications:
• Similar to forceps – second stage delay, fetal distress
• Preferred over forceps in many cases
🔸 Complications:
• Cephalohematoma
• Neonatal scalp injury
🔸 Nursing Role:
• Monitor baby’s head for swelling
• Observe for jaundice due to hematoma absorption
• Assist doctor with equipment setup
🔪 A surgical procedure to deliver the baby through incisions in the abdomen and uterus.
🔸 Types:
• Lower Segment Cesarean Section (LSCS) – commonly done
• Classical Cesarean – rarely done (vertical incision on uterus)
🔸 Indications:
• CPD
• Placenta previa
• Transverse lie
• Fetal distress
• Previous uterine scar
🔸 Post-op Care:
• Monitor vitals, uterine bleeding
• Encourage breastfeeding and early ambulation
• Care of surgical wound and pain management
• Watch for infection or DVT
☠️ Used when the fetus is already dead and vaginal delivery is not progressing.
🔸 Types:
• Craniotomy – crushing fetal skull
• Decapitation – separating fetal head
🔸 Used in obstructed labor or intrauterine fetal death (IUFD)
🛑 Now largely replaced by cesarean section
🔹 Explain the procedure and obtain informed consent
🔹 Ensure patient is NPO (nothing by mouth)
🔹 Start IV line, catheterization
🔹 Assist in pre-operative preparation (shaving, gowning)
🔹 Provide psychological support
🔹 Maintain sterile field
🔹 Monitor maternal vitals and fetal heart rate (FHR)
🔹 Hand over surgical instruments
🔹 Communicate with the mother during procedure (especially under spinal anesthesia)
🔹 Monitor for bleeding, uterine contraction, and vital signs
🔹 Encourage early breastfeeding and bonding
🔹 Observe surgical site (in C-section) or perineum (episiotomy)
🔹 Provide pain relief, iron & antibiotics as prescribed
🔹 Educate mother about hygiene, ambulation, nutrition
🟡 LSCS is the most common form of cesarean section
🟡 Vacuum delivery may cause scalp swelling (cephalohematoma)
🟡 Forceps delivery requires full cervical dilation and engaged head
🟡 Episiotomy is done during crowning
🟡 Classical cesarean is vertical and rarely done today
Q1. Which is the most commonly performed obstetric operation today?
🅰️ Forceps
🅱️ Vacuum
✅ 🅲️ Cesarean section
🅳️ Craniotomy
Correct Answer: 🅲️ Cesarean section
Q2. What is the most common complication of vacuum-assisted delivery?
🅰️ Skull fracture
🅱️ Brain hemorrhage
✅ 🅲️ Cephalohematoma
🅳️ Cleft palate
Correct Answer: 🅲️ Cephalohematoma
Q3. Which procedure is preferred when the fetal head is high and mother cannot push?
🅰️ Vacuum
✅ 🅱️ Cesarean section
🅲️ Forceps
🅳️ Episiotomy
Correct Answer: 🅱️ Cesarean section
Q4. Episiotomy is usually performed during which stage of labor?
🅰️ Latent phase
🅱️ Transition phase
✅ 🅲️ Second stage during crowning
🅳️ Third stage
Correct Answer: 🅲️ Second stage during crowning
Q5. Which of the following is NOT a nursing responsibility post-cesarean section?
🅰️ Monitoring for bleeding
🅱️ Supporting breastfeeding
✅ 🅲️ Vaginal packing
🅳️ Ambulation support
Correct Answer: 🅲️ Vaginal packing