Assisted vaginal birth Flashcards
What position is good for passive decent with an epidural
lateral position. Lower risk of needing instrumental
Which positions have a reduced rate of instrumental delivery
upright and lateral
although slight increased risk of 2nd degree tears
Situations in which forceps will be chosed over vacuum
- Malpresentation - face or breech extraction
- Dense epidural may impeded ability to push which is necessary for vacuum
- If birth needs to be quicker
- Less than 34 weeks
Complciations for assisted delivery for mums
Tears
Need for episiotomy
Birth trauma (mentally)
PPH
Pelvic floor damage
Urinary retention
Dyspareunia
Reasons why vacuum > forceps
Lower rates of epis/tears
Lower pain after delivery
Neonatal complications assisted deliveries
Facial trauma
Higher need for resus
Cephalohaematoma
Subgaleal haematoma
Subdural/subarachnoid haemorrhage
neurological injury
skull fracture
shoulder dystocia
jaundice
What are the two injuries on baby’s head that vacuum cups are at higher risk of and which one do we care about?
Cephalhaematomas - limited space. Deeper. Do not cross suture line.
Subgaleal haematomas - more superficial - BAD - mortality 20%. Large potential space and can result in shock
Why do assisted deliveries have a higher rate of early cessation of breastfeeding?
facial nerve injury
maternal or fetal pain
jaundice causing sedation
Materal indications for instrumental delivery
Maternal exhaustion - do not push until really feel the urge. Prolonged 1/2nd stage results in tiredness
Insufficient uterine activity - consider use of synto
Epidurals - impaired sensation. Definitely do passive decent if able
Maternal illness - extensive valsalva might be contrindicated for maternals disease e.g. cardiac
Materno-fetal indications for instrumental delivery
Malposition - OP babies can be manually rotated. OR rotated using forceps OR delivered with forceps/vacuum as OP
Malpresentation - mentum anterior can be delivered with facial forceps. NOT VACUUM
Macrosomia - might need instrumental but size needs to be assessed with examination prior to trying this
Fetal indications for instrumental delivery
Dodgy CTG in 2nd stage
2nd stage:
- nullips - after 2h 2nd stage or 3h with epidural
- multips - after 1h 2nd stage or 2h epidural
What are the conditions that need to be satisfied before instrumental birth attempted
- Maternal consent
- Baby in appropriate position
- Baby low enough
- Full dilatation
- Adequate pain relief
- Operative theatre if a trial
- Membranes ruptured
- No known disproportion of head and pelvis
What is an outlet procedure/low pelvic procedure/mid pelvic procedure/high pelvic procedure
Outlet - head at perineum, can be seen in contractions
Low - lower than +2
Mid - higher than +2
High - not engaged (these are not done anymore)
What is classified as a rotational procedure
more than 45 degree rotation
What is the acronym for vacuum cup delivery
Address woman - explain everything
Ask for help
Abdo palpation
Analgesia
Bladder - make sure empty with in-out catheter
Cervix - make sure fully dilated
Determine position
Equipment - make sure have birth tray and resus availability
Flexion point - 3cm anterior to posterior fontanelle
Gentle traction - constant gentle traction
Halt the procedure after 3 pop offs or if no decent after 3 pulls
Halt if been more than 20 minutes or consider after 10 to stop
Incision - episiotomy when crowning
Jaw - when jaw reachable remove vacuum and deliver