Instrumental

Question 1

What is the definition of an instrumental delivery?

Answer 1

the goal of operative delivery is it mimic spontaneous vaginal birth with minimum morbidity to maternal and neonate.

Question 2

What are the Indications of an instrumental?

X5

Answer 2

Malposition
Fetal distress
Prolonged/delayed second stage
Maternal exhaustion

Question 3

What are the contraindications?

X5

Answer 3

Unengaged head
Baby >4kg
Pelvic deformation (Cephalo-pelvix)/injury
Not fully dilated 
inexperienced operator 
Vaccum <34/40

Question 4

What are the prerequisites for instrumental?

Answer 4

Head 1/5th palpable
Vertex presentation
Fully
Exact position of the head determined

Question 5

What are the complications associated with instrumental delivery?
Mother X9
Baby X11

Answer 5

Mother:
Perineal trauma
Anal sphincter injury
Incontinence -faecal/flatulent/urinal
Urinary retention
infection 
PPH
DVT
psychological - PND 

Baby:	Cephalohaematoma 
Scalp abrasions 
Subdural haematoma 
Retinal haemorrhage
Brusing 
facial palsy
Feeding issues 
Headache 
irritability
jaundice 
admission to NNU

Question 6

When should a Instrumental be abandoned?

Answer 6

After three contraction if birth not imminent

Question 7

How can Instrumentals be avoided?

Answer 7

Effective pushing
Encouragement and support
Delayed pushing with epidural - primip

Question 8

What is the rate of instrumental deliveries in the UK?

Answer 8

10-13% RCOG 2011

Question 9

Are prophylactic abx used?

Answer 9

No significant evidence to support use

Question 10

Should episiotomys been routinely used?

Answer 10

individual judgement - no evidence to support

Question 11

What after care should be given?

Answer 11

reassessed for thromboprophylaxis
regular analgesia - paracetamol diclofenac
Bladder care - time volume (cath 12hours)
Debrief
Care individualised for 3/4th degree