Instrumental and operative delivery

Question 1

Why would you need a forceps or ventouse delivery?

Answer 1

If rotation or simply just more power was needed

Question 2

What is a ventouse?

Answer 2

A rubber or metal cap, connected to a handle; the cap is fixed near the fetal occiput by suction.

Question 3

How does a ventouse work?

Answer 3

Traction during maternal pushing will deliver the OA positioned head, but also often allows the shape of the pelvis to simultaneously rotate a malpositioned head to the OA positioning

Question 4

What are non-rotational forceps (Simpsons, Neville-Barnes) used for?

Answer 4

They grip the head in whatever position it is in and allow traction. Therefore they are only suitable with OA positioning

Question 5

What are rotational forceps (Kielland’s) used for?

Answer 5

They have no pelvic curve and enable a malpositioned head to be rotated by the operator to the OA position, before traction is applied.

Question 6

Which complications are more common with ventouse?

Answer 6

Failure (if the cup is placed wrong) and fetal complications (scalp swelling, lacerations, jaundice)

Question 7

What complications are more common with forceps?

Answer 7

Maternal complications (more analgesia and vaginal laceration and tears); fetal complications (facial bruising, facial nerve damage and even skull and neck fractures)

Question 8

What are some indications for instrumental vaginal delivery?

Answer 8

Prolonged second stage; fetal distress; prophylaxis (maternal cardiac complications); breech position (forceps)

Question 9

How is instrumental vaginal delivery prevented?

Answer 9

No maternal pushing til 1h after induction

Question 10

What are prerequisites for instrumental vaginal delivery?

Answer 10

The head must not be palpable abdominally and must be at or below the level of the ischial spines; 
The cervix must be fully dilated; 
The position of the head must be known; 
Must be adequate analgesia;
The bladder should be empty;
Valid indication for delivery

Question 11

What are some absolute indications for elective C section?

Answer 11

Placenta praevia; severe antenatal fetal compromise; uncorrectable abnormal lie; previous vertical Caesarean section and gross pelvic deformity

Question 12

What are some relative indications for elective C section?

Answer 12

Breech presentation, severe IUGR, twin pregnancy, DM and other medical diseases, previous C sections and older nulliparous patients

Question 13

What are some maternal complications of a C section?

Answer 13

Haemorrhage; blood transfusion; infection of the uterus or wound; VTE.

Question 14

What is done to prevent some maternal complications during C section?

Answer 14

Prophylactic antibiotics and thromboprophylactic measures are taken

Question 15

What are some fetal complications of a C section?

Answer 15

Fetal respiratory morbidity; fetal lacerations; bonding and breastfeeding are affected by emergency procedures