Instrumental Birth

Question 1

Name some fetal indications for an instrumental birth

Answer 1

Malposition
Presumed fetal compromise 
Fetal hypoxia [confirmed with FBS] 
Babies <1.5kg
Assisted breech birth

Question 2

Name some maternal indications for an instrumental birth

Answer 2

Maternal distress
Exhaustion
Prolonged 2nd stage
Medically conditions requiring prophylactic instrumental birth

Question 3

Absolute Contraindications to Assisted vaginal birth

Answer 3

Vertex < 1/5 palpable abdominally 
Unknown position of head 
Before full dilatation 
Inexperience operator 
Ventuose <34 + 6 wks 
Face presentation 
Caput that may impede cup placement

Question 4

Perquisites for Assisted Vaginal Birth

Answer 4

Fully Dilated
Rupture of Membranes 
Cephalic presentation w/identification of position 
Fetal head must be <1/5 palpable 
Adequate analgesia 
Empty bladder 
Experienced operator

Question 5

Describe the procedure of a vacuum birth

Answer 5

Procedure discuss w woman
Adequate analgesia
CTG on
Determine flexion point 3cm to posterior fontanelle
Traction must be consistent with maternal expulsive effort and a contraction
Once the head has crowned release the vacuum

Question 6

Maternal Complications of a Vacuum Birth

Answer 6

Less traumatic to the mother

Risk of laceration due to entrapment of vaginal mucosa between suction cup and fetal head

Question 7

Fetal Complications of Vacuum Birth

Answer 7

Chignon 
Abrasion and Laceration 
Scalp necrosis
Cephalohaemonatoma
Intracrainial haemorrhage 
Subgleall haematoma

Question 8

What percentage does a cehpalohaematoma increase the risk of neonatal jaundice?

Answer 8

25 percent

Question 9

DIfference between a cephalohaematoma and subgleal haematoma?

Answer 9

Cephalohaematoma does not cross cuture lines.

Subgleal haematoma does cross suture lines and can cause diffuse swelling that may indent on palpation

Question 10

What are Wrigley’s forceps used for?

Answer 10

‘Lift out’ when the head is on the perineum

Question 11

What are Neville Barnes forceps used for?

Answer 11

Most common! low- mid cavity

Question 12

What are Kielland Forceps used for?

Answer 12

Used for rotation- not commonly used anymore

Question 13

Procedure of Forceps

Answer 13

Adequate analgesia (usually with an EDB)
Left blade inserted first with hand protecting the vaginal wall.
Apply right blade and lock
Traction applied with maternal effort

Question 14

Maternal complications of a forceps birth?

Answer 14

Trauma or soft tissue damage
Increased perineal discomfort
Dysuria or urinary retention
Haemmorhage

Question 15

Neonatal complications of a forceps birth

Answer 15

Bruising to scalp and face 
Facial palsy 
Skull Fracture 
Retinal damage 
Cephlahaematoma