Instrumental Deliveries

Question 1

When is forceps delivery indicated?

Answer 1

Delay in second stage (poor maternal effort, epidural)
Maternal indications (cardiac disease, resp disease, uncontrolled BP, previous c/s
Fetal indications (fetal distress, aftercoming head of the breech)

Question 2

Types of obstetric forceps?

Answer 2

Long-shaft - Neville-Barnes
Short-shaft - Wrigley, Pijper
Rotational - Keillands

Question 3

Prerequisites for forceps delivery?

Answer 3

Vertex/ aftercoming head. Head engaged. Pelvis adequate size. ROM. Empty bladder. Adequate contractions. Episiotomy. Saggital suture in AP. Adequate analgesia. Indication valid. Experienced physician.

Question 4

When is traction applied in forceps delivery?

Answer 4

Only during contractions

Question 5

What are the maternal complications of forceps delivery?

Answer 5

Lacerations. PPH. Puerperal infection. Trauma to bladder or rectum. Neurological injuries. Long term- pelvic organ prolapse/incontinence

Question 6

What are the fetal complications of forceps delivery?

Answer 6

Death. Skull fracture. Intracranial haemorrhage. Facial nerve palsy. Lacerations and bruising. Brachial plexus injury.

Question 7

What are the indications for vacuum extraction?

Answer 7

As for forceps, but can be used if saggital suture not in AP

Question 8

Contraindications for vacuum extraction?

Answer 8

Prem. breech/face presentation. Head not engaged/ evidence of CPD. Inadequate contractions. Uncooperative/ unconscious patients. Possible bleeding tendency of fetus. HIV.

Question 9

Advantages of vacuum extraction?

Answer 9

Facilitates flexion of fetal head. Allows rotation in atraumatic way. Episiotomy not always necessary. Less maternal trauma. Allows limited traction force to be used (+/-10kg).

Question 10

Disadvantages of vacuum extraction?

Answer 10

Higher risk of fetal injury

Delivery takes longer than forceps

Question 11

What are the fetal complications of vacuum extraction?

Answer 11

Abrasions, lacerations, contusions. Chignon (artificial caput succedaneum). Cephalohaematoma. Intracranial haemorrhage. Anaemia and jaundice.

Question 12

What are the maternal complications of vacuum extraction?

Answer 12

As for forceps but lesser extent

Question 13

What are the guidelines for instrumental delivery?

Answer 13

Supervisor must be suitably trained
Appropriate analgesia should be used 
Cervix fully dilated
Fetal head engaged
Favourable presentation (vertex, deflected vertex or face, unless vacuum)