Instrumental Delivery Flashcards
Indications of Forceps?
Delay in 2nd stage of labour - poor maternal effort or exhaustiin.
Maternal Indications
Cardiac and Resp Disease
Uncontrolled BP
Previous C- section
Fetal Indications
Fetal distress
Aftercoming head of breech
Types of Obstetric Forceps
Long shaft - neville barnes
Short shaft - wrigley, not generally used, useful for delivering head at C/S
Rotational Forceps - keillands, not used, fetal and pelvic trauma
Prerequisites of Forceps Delivery?
- vertex delivery or aftercoming head of breech
- term infant
- less then 1/5 head above brim, no CPD
- pelvis must be adequate size
- cervix fully dilated
- membranes ruptured
- empty bladder
- adequate uterine contractions
- episiotomy
- saggital suture in AP
- idenitfy posterior fontanelle
- afequate analgesia
Preparation for Forceps Delivery?
- analgesia
- lithotomy position
- selection of instrument
- episiotomy
- left blade applied first
- traction - only during contractions
Complication of Forceps Delivery?
Maternal
- lacerations vagina cervix uterus
- pph due to tears or uterine atony
- puerperal infection
- trauma to bladder or rectum
- long term -pelvic organ prolapse/incontinence
Fetal
- death
- skull fracture
- intracranial hge
- facial nerve palsy
- lacerations
- brachial plexus injury
Indications for a Vacuum extractor?
Same as forceps but can be used when saggital suture is not in the AP position.
Contraindications of Ventouse?
-prem
Dis/Advantages of Ventous
- facikitaes flexion of head
- allows rotation without trauma
- occupies no extra space therefore episiotomy not needed
- less maternal trauma
Disadv
Higher risk of fetal injury
Delivery takes longer than with forceps
Complications of Ventouse?
Fetal - abrasions lacerations on scalp -chignon (arificial caput succedaneum -cephalohaematoma -hg under periosteum Intracranial hge -anaemia and jaundice
Maternal
As for forceps but lesser extent
What are the use of Forceps?
Expedite delivery in second stage of labour.
After coming head of breech.
Delivery of head at c-section.
Contraindications in instrunental delivery?
Fetal bleeding disorder -thrombocytopaenia
Predisposition to fracture- osteogenesis imperfecta
When has a vacuum extraction failed?
- head is not advancing with each pull
- fetus is undelivered after 3 pulls with no decent or after 20mins.
- cup slips off the head twice with a proper direction of pull and maximum negative pressure.
During instrumental delivery, what is NB to check between contractions?
Fetal Heart Rate
Application of forceps( if forceps wont lock, then wrong application)
