Instrumental Delivery

Question 1

So these flashcards will concern methods of instrumental delivery. The popularity of the methods varies between countries (forceps are not used in Poland).

What are the three main categories of instrumental delivery?

Vital information missing from notes - review lecture slides and fill in missing information marked with (???) !*

Answer 1

1. Forceps
2. Vacuum extractor
3. Destructive vaginal operations

Question 2

Let’s start with use of FORCEPS, what are the components:

Answer 2

Blades (cephatic and pelvic curve), shank, handle, toe

Question 3

What are the conditions necessary for the forceps? *Hint: there are 9 of them

Answer 3

1. For one, Cervix must be fully dilated
2. Ruptured membranes
3. Engaged heads
4. at least +2 station (???)
5. Absolute knowledge of fetal position
6. No evidence of CPD (cephalopelvic disproportion ??)
7. Adequate anesthesia
8. Empty bladder
9. Experienced operator (most important)

Question 4

Now when it comes to the vacuum extractor - it is important to place the cup properly (presenting part of the leading cup) - where should it be placed? (what happens if placed anywhere else?
Also, one thing check after placing the cup?

Answer 4

It should be placed over the posterior fontanelle! - the head will be abnormally formed if put it anywhere else…

You have to take a finger around the cup and be sure that no vaginal wall is in the cup, this can give a vaginal laceration!

Question 5

When should vacuum NEVER be used?

Answer 5

In cases when position is unknown, or the head is too high, vacuum should never be used!

Question 6

So, what are the indications for use of vacuum extractor? *Gimme 5 of’em (which includes maternal indications).

Answer 6

1. Fetal distress in 2nd stage
2. Dilatation >7cm !
3. Prolapsed cord
4. Maternal indications: physical distress; to avoid maternal effort in patient with hypertenionsion; cardiac and respiratory disease
5. Obstetric indications: Problems with 2nd twin.

Question 7

Okay, so what are 2 important contraindications for vacuum extraction?

Answer 7

1. Malpresentation (face, brow, breech tranverse line) - this makes sense, thing about it;)
2. Caogulopathy of the baby (intracranial hemorrhage, cephalohematoma

Question 8

And to finish of this vacuum extraction stuff: What are some possible complications from vacuum use?

Answer 8

For the infant: scalp laceration and cephalohematoma.

A rare complication: subgaleal hemorrhage (this is a neonatal emergency)

Question 9

So, to finish off this instrumental delivery stuff, what is an episiotomy, and what are indications and contraindications?

Answer 9

Episiotomy is an incision made in the perineum to facilitate delivery.

Indication is the need to hasten delivery and impending or ongoing shoulder dystocia.

A relative contraindication is the assessment that there will be a large perineal laceration (episiotomy is after all associated witha higher risk of severe perineal lacerations.

The rate of third- and fourth-degree lacerations increases with the use of routine midline episiotomy (only used when indications present (???)

Question 10

What are the two commone types of episiotomy=

Answer 10

There is the median/midline, and the mediolateral type. (see picture)

Question 11

What are the two commone types of episiotomy?

Answer 11

There is the median/midline, and the mediolateral type. (see picture)