Assisted Birth

Question 1

What are the indications for assisted birth?

Answer 1

• Actual or anticipated fetal compromise.
• Persistent malposition of the fetal head (occipito-lateral and occipito-posterior).
• Prolonged/delay in 2nd stage. In a primigravida > 2 hours without an epidural (3 hours with an epidural) and in a multipara > 1 hour without and epidural (2 hours with an epidural).
• Maternal exhaustion/fatigue.
• In cases of medically significant conditions such as aortic valve disease, myasthenia gravis, and severe hypertensive disease.

Question 2

What are the contra-indications for assisted birth?

Answer 2

The vertex is more than 1/5th palpable abdominally.
• The position of the fetal head is unknown.
• Before full dilatation of the cervix (although possible exception is with the vacuum delivery of a second twin).
• When the operator is inexperienced in the use of the instruments.

Question 3

When should The ventouse not be used?

Answer 3

• In gestations of < 35 completed weeks because of the risk of intracranial haemorrhage.
• In face presentations.
• If there is a significant degree of caput that may preclude correct placement of the cup
• substantial degree of cephalopelvic disproportion.

Question 4

Name the three types of forceps and what is their use?

Answer 4

• Wrigleys: Short curved forceps used for low or outlet deliveries.
• Neville-Barnes: Long curved forceps used for midcavity deliveries.
• Kielland’s Forceps: Long forceps characterised by minimal pelvic curve, a sliding lock and knobs on the handle. These forceps are used for rotation.

Question 5

What are the Pre-requisites and clinical considerations for assisted vaginal delivery?

Answer 5

Informed consent
Ruptured membranes
fully dilated cervix
confirmed cephalic presentation
head less than 1/5th palpable abdominally
presenting part must be at or below spines
cephalopelvic disproportion should be eliminated
adequate analgesia
if contractions are weak commence oxytocin infusion
Bladder is empty
document throughout
adequate facilities and back up personal

Question 6

what are some of the elements that indicate high risk of vontouse failure

Answer 6

High BMI >30
Macrosomic baby
OP position
station and position of head not accurately diagnose
significant caput/ moulding
weak infrequent contractions
maternal fatigue/exhaustion

Question 7

What are the Requirements & preparation of woman for Ventouse & Forceps Procedures?

Answer 7

• Birth pack
• gown gloves and obstetric cream
• lithotomy
• ventouse / forceps
• Local anaesthetic – Xylocaine 1%
• 10ml syringe and 19g and 23g needles.
• in out catheter
• paed call
• check function of instrument
• oxytocin infusion

Question 8

How many pulls on vontouse is the obs permitted to use?

Answer 8

• 3 pulls with little progress should be ceased
• 3 pulls resulting in the head at the introitus permits another 3 pulls if necessary
• If no decent after 2 pulls procedure should be stopped and delivery completed by caesarean section.

Question 9

What are the Known Complications of vontouse delivery?

Answer 9

Baby:
• Chignon will develop
• Cephalhaematoma
• Retinal Haemorrhage
• Jaundice
• Cerebral irritation
• Scalp abrasions/lacerations and sloughing
• Intracranial haemorrhage
• Subaponeurotic haemorrhage (rare but potentially fatal)
Mother:
• Perineal lacerations
• Tears/extensions of episiotomies
• Cervical tears.
• Postpartum haemorrhage

Question 10

What are the know complications for forceps delivery?

Answer 10

Baby:
• Forceps marks and bruising to the face.
• Transient or permanent facial nerve damage.
• Retinal Haemorrhage
• Cephalhematomas
• Intracranial haemorrhage
• Subaponeurotic haemorrhage (rare but potentially fatal)
Mother:
• Perineal lacerations
• Tears/extensions of episiotomies
• Postpartum haemorrhage
• Damage to the rectal sphincter 8
• Urinary and/or faecal incontinence.
• Fistulae.
• Ruptured uterus (rare).

Question 11

What is necessary directly after an assisted birth

Answer 11

take paired cord blood samples for pH.