Assisted delivery

Question 1

fetal indications for assisted labour

Answer 1

1. cord prolapse
2. fetal distress
3. after coming of the head in a breech delivery.

Question 2

maternal indications of assisted labour

Answer 2

• delayed second stage of labour
• exhaustion
• maternal medical contraindications

Question 3

types of forecepts

Answer 3

1. Wrigley’s outlet
2. Neville- Barnes

Question 4

Wrigley’s outlet

Answer 4

• can help in delivery of the head at C/S
• has shorter handles
• good for performing outlet vaginal delivery

Question 5

Neville- barnes

Answer 5

• recommended for use by experienced practitioners
• used for mid cavity forceps delivery
• sagittal sutures must be in AP diameter of the pelvis before application

Question 6

advantages of forcepts

Answer 6

1. can be used in the after coming of the head of a breech
2. speed of delivery – no need to wait for suction build up
3. can be used in preterm delivery
4. can be used in HIV positive Women

Question 7

13 conditions that need to be met before use of forcepts/vaccum.

Answer 7

1. there must be a clear indication
2. a practitioner must be familiar with the procedure.
3. a careful pelvis assessment must be performed.
4. if in doubt of possible CPD then procedure must be done in theatre as a trial of forcerpts.
5. the cervix must be fully dilated
6. the biparietal diameter must have entered the pelvic brim
7. The sagittal sutures must be in direct AP position of the pelvis.
8. The uterus must be contracting adequately and traction must be made during contractions with maternal bearing down efforts.
9. there must be adequate anaesthesia.
10. the bladder must be empty.
11. An Adequate episiotomy is usually necessary.
12. correct application of the blades is confirmed by parallel closure and approximation of the blades.
13. there must be decent traction, if not forceps must be removed.

Question 8

advantages of vacuum extraction

Answer 8

Improves flexion of the fetal head and allows for rotation as the head descends.

Question 9

contraindications of use of a vacuum

Answer 9

1. preterm
2. where maternal assistance is lacking or contraindicated
3. HIV positive patients with unsupported VL (consider forcepts delivery)

Question 10

procedure

Answer 10

1. use the largest cup possible (metal or Kiwi disposable cup)
2. check the vaccum and apparatus on a gloved hand before application
3. apply vaccum 3 cm anterior to the posterior fontanelle to promote flexion
4. induce vaccum to not more than minus 0,8 kg/cm2
5. only pull with contractions and maternal bearing down efforts
6. there must be decent and rotation with every traction
7. the cup can only be replaced on the head 3 times otherwise its a failed vacuum
8. perform C/S
9. FORECEPTS SHOULD NOT BE USED AFTER A VACCUM UNLESS THE HEAD IS ON THE PERINEUM.