Assisted Delivery

Question 1

What are the methods of assisted delivery?

Answer 1

Ventouse (Kiwi/vaccum)
Forceps
C-section

Question 2

Why is assisted delivery performed?

Answer 2

Failure of labour to progress
Foetal distress

Question 3

What are the maternal complications of instrumental delivery?

Answer 3

Failure
Pain
Vaginal laceration
Perineal tear
PPH

Question 4

What are the foetal risks associated with instrumental delivery?

Answer 4

Chignon (scalp swelling)
Scalp laceration
Trauma (CNVII damage)

Question 5

What are the indications for instrumental delivery?

Answer 5

Prolonged second stage (>1hr delivery)
Maternal exhaustion
Foetal distress
Breech delivery
Contraindication to pushing (medical condition)

Question 6

What are the pre-requisites for instrumental delivery?

Answer 6

Head is engaged (at or below ischial spine)
Cervix fully dilated
Position of head is know (LOA, LOP etc.)
Analgesia
Bladder empty

Question 7

What is the most common type of C-section?

Answer 7

Lower segment Ceserean section (LSCS)

Question 8

Why would a vertical incision be performed during a C-section?

Answer 8

Transverse lie
Placenta praevia
Large fibroid
Extreme prematurity

Question 9

What are the indications for an emergency C-section?

Answer 9

1. Failure to progress
   Powers - insufficient contractions
   Passage - inadequate pelvis
   Passenger - malpresentation, distress
2. Foetal distress

Question 10

What is a category 1 C-section and when should it be performed?

Answer 10

Emergency C-section (immediate threat to life) - perform within 30 minutes

Question 11

What are the indications for elective C-section?

Answer 11

Patient preference
Previous C-section (>2)
Placenta praevia
Transverse lie
Gross pelvic deformity

Question 12

What are the maternal complications relating to C-sections?

Answer 12

Pain
Infection
Bleeding
Need for transfusion
Damage to local structures
VTE/PE

Question 13

What are the foetal complications associated with C-section?

Answer 13

RDS
Laceration
Bonding and breastfeeding difficulties

Question 14

What are the contraindications to VBAC?

Answer 14

Vertical scar
2 or more previous C-sections
History of uterine rupture
History of myomectomy
Contraindication during this pregnancy (unstable lie, placenta praevia)

Question 15

What are the risks associated with VBAC?

Answer 15

Emergency C-section
Placenta praevia (due to old scar)
Uterine rupture (scar)
Bleeding
Risks of normal vaginal delivery (tear, instruments, foetal distress etc.)