18) Forceps & Vacuum Delivery - Indications, Pre-requsisites, Technique

Question 1

What is the Definition of Forceps & Vacuum Delivery?

Answer 1

• Type of assisted vaginal delivery
• Where there’s direct traction on Fetal Head
• Using Forceps or Vacuum

Question 2

What are the Indications for F&V?

Answer 2

• Prolonged 2nd Stage of Labor
• Maternal Illness - Heart Disease, Pulmonary
• Non-Reassuring Fetal Status

FOR FORCEPS

• Breech presentation
• Cord Prolapse / Preeclampsia
• Maternal EXHAUSTION

FOR VACUUM

• Fetal DISTRESS
• Mother with CVS Disease
• Maternal EXHAUSTION

Question 3

What are the Pre-Requisites?

Answer 3

• FULLY DILATED Cervix - 10cm
• Fetal Head is Engaged in Cephalic Presentation
• Empty Bladder
• Membranes MUST BE Ruptured

Question 4

What is the Technique for FORCEPS?

Answer 4

1) Make sure bladder is empty
2) Disinfection
3) Vaginal Exam - to assess the Fetal head position
4) Use Correct Instrument
5) External FORMATION + ORIENTATION of Forceps
6) Anesthesia

7) TRIAL Extraction
8) Traction + Extraction of FETAL HEAD
9) Extract the Shoulders + Body
10) EPISIOTOMY

Question 5

What are the Maternal / Fetal COMPLICATIONS for FORCEPS?

Answer 5

MATERNAL

• Rupturing of Vagina, Vulva + Perineum
• Stretching the Symphysis
• Injuries to Bladder, Rectum + Pelvic Nerve Plexuses

NEWBORN

• Damage to SOFT TISSUE of Head
• Bone Fracture
• Intracranial Hemorrhage
• Paralysis / Paresis of Facial, Cervical + Brachial Nerves

Question 6

What is the Technique for VACUUM?

Answer 6

1) Insert the Cap (Metal / Silicone)
2) Occipital Placement of Vacuum Cup
3) Check the fit of Vacuum Cup
4) Do a TRIAL TRACTION
5) Traction + Deflection of Fetal HEAD

Question 7

What are the COMPLICATIONS for VACUUM?

Answer 7

FETAL SCALP INJURIES

1) Caput Succedaneum - Swelling of Soft Tissue

2) Cephalohematoma - Collection of Blood Between Periosteum + Skull

3) Subgaleal Hematoma -SEVERE Hemorrhage

Intracranial Hemorrhage
Shoulder Dystocia