Instrumental Delivery

Question 1

2 methods of instrumental delivery

Answer 1

forceps or ventouse

Question 2

how common are instrumental deliveries?

Answer 2

10% births in the UK

Question 3

Prophylactic drug for an instrumental delivery

Answer 3

co-amoxiclav

Question 4

4 indications for instrumental delivery

Answer 4

failure to progress

foetal distress

maternal exhaustion

control of the head in different positions (e.g. in breech delivery)

Question 5

6 maternal risks associated with an instrumental delivery

Answer 5

injury to the femoral or obturator nerves

PPH

episiotomy

perineal tears

injury to the anal sphincter

incontinence of the bladder or bowel

Question 6

most common risk to the neonate with:

ventouse

forceps

Answer 6

cephalohaematoma

facial nerve palsy/injury

Question 7

serious neonatal complications of instrumental delivery (4)

Answer 7

intracranial haemorrhage

subgaleal haemorrhage

spinal cord injury

skull fractures

Question 8

where does a cephalohaematoma form? (i.e. what layers)

Answer 8

forms between the skull and the periosteum

Question 9

why would a forceps delivery cause a neonate to have hard lumps on the side of their head?

Answer 9

can occasionally cause fat necrosis, and this leads to hard lumps of fat on the sides of the head

Question 10

prognosis of fat necrosis

prognosis of cephalohaematoma

Answer 10

both of these resolve slowly over time

cephalohaematoma can result in neonatal jaundice

Question 11

f there is nerve injury to the mother during an instrumental delivery, how quickly does this resolve?

Answer 11

generally it takes about 6-8 weeks

Question 12

3 features of femoral nerve injury

Answer 12

numbness over the anterior thigh

loss of the patella reflex

weakness of extension of the knee

Question 13

3 features of obturator nerve injury

Answer 13

numbness over the medial thigh

weakness of hip flexion

weakness of hip internal rotation

Question 14

how would the lateral cutaneous nerve of thigh be injured during childbirth?

how would this present?

Answer 14

prolonged flexion of the hip (e.g. in lithotomy position) can cause compression of the inguinal ligament into this nerve

presents with numbness of the anterolateral thigh

Question 15

how would the lumbosacral plexus be injured during childbirth?

how would this present?

Answer 15

can become compressed by the neonate’s head during the second stage of labour

foot drop + numbness of the anterolateral thigh + numbness of the leg and foot

Question 16

how would the common perineal nerve be injured during childbirth?

how would this present?

Answer 16

compression of the outer knee whilst in the stirrups in the lithotomy position

presents with foot drop and numbness of the lateral leg