Instrumental delivery

Question 1

Instrumental delivery

Types

Answer 1

1. Rotational (used when anterior rotation is required – OP, OT positions)
2. Non-rotational (used when no anterior rotation is required – OA position)

Question 2

Rotational types

Answer 2

1. Rotational (used when anterior rotation is required – OP, OT positions)

a. Forceps - Kielland’s forceps

b. Vacuum extractor

i.Posterior cups - flexible tube so it can be put onto the fetal occiput as posterior as possible not on the fontanelle to aid with the head flexion and anterior rotation. Used in coordination of maternal contractions and efforts.

Question 3

Non-rotational types

Answer 3

Non-rotational (used when no anterior rotation is required – OA position)

a. Forceps

i. Simpson’s and Neville Barnes forceps

• Left or right blades that fit either side of the pelvis

• Cephalic and pelvic curves

• Fix-lock between the blades

b. Vacuum extractor

i. Anterior cups

Question 4

Instrumental delivery

Indications

Answer 4

1. Delay in second stage of labor
2. Non-reassuring fetal status (fetal distress) 3. Maternal exhaustion
3. Perineal resistance
4. CPD
5. Maternal medical disorders
6. Insufficient uterine contractions or poor expulsive efforts
7. Head malposition
8. Epidural analgesics

Question 5

Instrumental delivery

Conditions

Answer 5

1. Full cervical dilatation and effacement
2. Vertex presentations
3. Head engaged
4. Empty bladder
5. Analgesics

Question 6

Instrumental delivery

Mathods

Answer 6

1. If descent is not evident with each traction the procedure should be ceased and C-section should be done.
2. Non-rotational instrumental delivery

a. Forceps
i. Simpson’s and Neville Barnes forceps are used.

Sagittal suture should be perpendicular to shank.

Intermittent traction should be used in accordance to uterine contractions.

B. Vacumm

Cup is attached to baby’s head at vertex
Traction along the axis of the pelvis

Question 7

Instrumental delivery

Methods

Answer 7

1. If descent is not evident with each traction the procedure should be ceased and C-section should be done.
2. Non-rotational instrumental delivery

a. Forceps
i. Simpson’s and Neville Barnes forceps are used.

Sagittal suture should be perpendicular to shank.

Intermittent traction should be used in accordance to uterine contractions.

B. Vacumm

Cup is attached to baby’s head at vertex
Traction along the axis of the pelvis