Instrumental Delivery Flashcards
Definition
Vagina delivery assisted by either a ventouse suction cup or forceps.
- Tools are used to help deliver the baby’s head.
- Can usually be carried out on the labour ward, however if there are concerns, may be moved to theatre.
- Single dose co-amoxiclav is recommended after instrumental delivery to reduce the risk of maternal infection.
Indications for assisted birth
Failure to progress
Fetal distress
Maternal exhaustion
Control of the head in various fetal positions
Risk factors
Epidural delivery
Having an instrumental delivery increases the risk to the mother of:
- Postpartum haemorrhage
- Episiotomy
- Perineal tears
- Injury to the anal sphincter
- Incontinence of the bladder or bowel
- Nerve injury (obturator or femoral nerve)
Having an instrumental delivery increases the risk to the foetus of:
- Cephalohaematoma with ventouse
- Facial nerve palsy with forceps
Serious risk to the children
- Subgaleal haemorrhage (most dangerous)
- Intracranial haemorrhage
- Skull fracture
- Spinal cord injury
Ventouse
Suction cup on a cord
- goes onto the baby’s head
- main complication: cephalohaematoma. This involves a collection of blood between the skull and the periosteum.
Forceps
Large metal salad tongs
- Go either side of the baby’s head and grip the head
- The main complication for the baby is facial nerve palsy, with facial paralysis on one side.
- Can leave bruises on the baby’s face.
- Rarely the baby can develop fat necrosis, leading to hardened lumps of fat on their cheeks. Fat necrosis resolves spontaneously over time.
Rare complication of mother
Nerve injury
- usually resolves over 6-8 weeks
- Affected nerve: femoral nerve, obturator nerve
How femoral nerve damage occurs
Against the inguinal canal during a forceps delivery.
- causes weakness of knee extension, loss of the patella reflex and numbness of the anterior thigh and medial lower leg.
How obturator nerve damage occurs
May be compressed by forceps during instrumental delivery or by the fetal head during normal delivery.
- Injury causes weakness of hip adduction and rotation, and numbness of the medial thigh.
Other nerve injuries which can occur
- Lateral cutaneous nerve of the thigh
- Lumbosacral plexus
- Common peroneal nerve
ateral cutaneous nerve of the thigh pathophys
Runs under the inguinal ligament. Prolonged flexion at the hip while in the lithotomy position can result in injury, causing numbness of the anterolateral thigh.
lumbosacral plexus pathophys
May be compressed by the fetal head during the second stage of labour. Injury to this network of nerves nerve can cause foot drop and numbness of the anterolateral thigh, lower leg and foot.
Common peroneal nerve pathophys
May be compressed on the head of the fibula whilst in the lithotomy position. Injury to this nerve causes foot drop and numbness in the lateral lower leg.
