Instrumental Delivery Flashcards
Instrumental Delivery
Refers to a vagina delivery assisted by either a ventouse suction cup or forceps
How to reduce the risk of maternal infection
Single dose of co-amoxiclav after the instrumental delivery
Indications for an instrumental delivery
Failure to progress
Fetal distress
Maternal exhaustion
Control of the head in various fetal positions
Risk factor for instrumental delivery
Epidural
Risks of an instrumental delivery
Risk to mother:
- Postpartum haemorrhage
- Episiotomy
- Perineal tears
- Injury to the anal sphincter
- Incontinence of the bladder or bowel
- Nerve injury (obturator or femoral nerve)
Risk to baby:
- Cephalohaematoma with ventouse
- Facial nerve palsy with forceps
Serious risks to the baby
Subgaleal haemorrhage (most dangerous)
Intracranial haemorrhage
Skull fracture
Spinal cord injury
Ventouse
Suction cup on a cord
The suction cup goes on the baby’s head, and careful traction is applied
Complications of a ventouse delivery
Cephalohaematoma - collection of blood between the skull and the periosteum
Complications of a forceps delivery
Facial nerve palsy - facial paralysis on one side
Bruises on the baby’s face - jaundice due to heamolysis
Rarely fat necrosis - leading to hardened lumps of fat on their cheeks (resolves spontaneously)
When do nerve injuries resolve
6 - 8 weeks
Which nerves can be damaged in a forceps delivery
Femoral nerve
Obturator nerve
Femoral nerve injury presentation
Weakness of knee extension
Loss of the patella reflex
Numbness of the anterior thigh and medial lower leg
Obturator nerve injury presentation
Weakness of hip adduction and rotation
Numbness of the medial thigh
Other nerve injuries not caused by forceps delivery
Lateral cutaneous nerve of the thigh
Lumbosacral plexus
Common peroneal nerve
Lateral cutaneous nerve of the thigh injury
Prolonged flexion at the hip while in the lithotomy position can result in injury, causing numbness of the anterolateral thigh.
