forceps and vaccum assisted delivery

Question 1

what are forceps

Answer 1

double-bladed metal instrument that is used for extraction of the foetal head

Question 2

list the maternal indications for forceps use

Answer 2

• Maternal exhaustion following prolonged labour.
• Prolonged second stage of labour
• Maternal distress
• Maternal medical disorder (like cardiac disease, severe anaemia, tuberculosis, pregnancy induced hypertension, eclampsia)
• Failure of decent/internal rotation in second stage of labour
  
  • 2 hrs. primi
  • 1hr.multi

Question 3

define prolonged 2nd stage of labour

Answer 3

In nulliparity

more than 3 hours

more than 2 hours without regional anaesthesia

In multiparity:

more than 2 hours

more than 1 hour without regional anaesthesia

Question 4

what 3 features define maternal distress

Answer 4

tachycardia, dehydration, mild pyrexia

Question 5

which specific maternal medical disorders are forceps indicated in

Answer 5

• pregnancy induced hypertension & eclampsia)
• cardiac disease
• severe anaemia
• tuberculosis,

Question 6

List the fetal incations of Forceps use

Answer 6

1. Foetal distress in second stage of labour
2. Delivery of the head in breech.
3. Acute emergencies e.g. cord prolapse or if the cord loops around the neck causing severe hypoxia

Question 7

what are the 9 pre-requisites for forceps

Answer 7

1. Verbal or written consent
2. The cervix must be completely dilated.
3. The membranes must be ruptured.
4. The head must be engaged.
5. The position of the foetal head must be known
6. The foetus must be vertex or present a face with chin anterior.
7. Adequate analgesia.
8. Bladder must be emptied
9. No cephalopelvic disproportion

Question 8

how are forceps applioed

Answer 8

• For application of left blade-two or more fingers of right hand are introduced inside the left posterior portion of vulva and into vagina beside the foetal head.
• The handle of left branch is then grasped between the thumb and two fingers of left hand and introduce under the guidance of right hand.
• For application of right blade-two or more fingers of left hand are introduced into the right posterior position of vagina to serve as guide for right blade

Question 9

types of forceps app

Answer 9

cephalic: ideal method of application

pelvic

Question 10

descripe cephalic application

Answer 10

blades are applied along the sides of the head grasping the biparietal diameter in between the widest part of the blades.

The long axis of the blades corresponds more or less to the occipitomental plane of the foetal head.

It is the ideal method of application as it has got a negligible compression effect on the cranium.

Question 11

describe pelvic application

Answer 11

blades of the forceps are applied on the lateral pelvic walls ignoring the position of the head

If the head remains unrotated, this type of application puts serious compression effect on the cranium and thus must be avoided.

Question 12

important things to know when applying blades

Answer 12

The biparietal diameter corresponds to the greatest distance between the blades.

The head of foetus is perfectly grasped only when long axis of blades corresponds to o_ccipitomental diameter_.

If one blade is applied over brow and other on occiput, instrument cannot be locked and if locked, blades will slip off when traction is applied.

Question 13

what is Vacuum Extraction

Answer 13

aka Ventouse is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp

Question 14

indications for vacuum

Answer 14

same as forceps except reserved for foetuses who have attained a gestational age of 34 weeks

Question 15

pre-requisites of vacuum

Answer 15

• Procedure explained to the patient and take consent
• Emotional support and encouragement
• Lithotomy position.
• Bladder should be emptied.
• Antiseptic measures for the vagina, vulva and perineum.
• Vaginal examination to check :
  
  • pelvic capacity,
  • cervical dilatation,
  • presentation, position, station
  • degree of flexion of the head
• membranes are ruptured

Question 16

application of the cup

Answer 16

step 1: apply cup

step 2: traction

Question 17

explain step 1 of vacuum application

Answer 17

• The largest possible cup is to be selected.
• ntroduced after retraction of the perineum with two fingers of the other hand
• placed against the foetal head nearer the occiput = flexion-point
• vacuum of 0.2 kg/cm2 is induced slowly, for 2 minutes.
• A check is made using the fingers round the cup to ensure that no cervical or vaginal tissue is trapped inside the cup.
• The pressure is gradually raised at the rate of 0.1 kg/cm2 per minute
• Done until the effective vacuum of 0.8 kg/cm2 is achieved in about 10 minutes time.
• The scalp is sucked into the cup and an artificial caput succedaneum (chignon) is produced.
• The chignon usually disappears within few hours.

Question 18

Step II: Traction:

Answer 18

• Traction must be at right angle to the cup
• Traction should be synchronous with the uterine contractions
• Traction is released in between uterine contractions
• Traction should be made using one hand along the axis of the birth canal. The fingers of the other hand are to be placed against the cup to note the correct angle of traction, rotation and advancement of the head