Instrumental Delivery

Question 1

How does a (kiwi) ventouse work?

Answer 1

Consists of applying cap to occiput and then traction during pushing

NB - dont use for more than 30 mins or more than 3 pulls with each contraction

Question 2

How do non-rotational forceps work? (neville barnes, haigh ferguson, simpsons)

Answer 2

Consists of two blades:

• cephalic curve grasps the foetal head
• pelvic curve conforms to the axis of the birth canal

These can only be used in OA position

Question 3

How do rotational forceps work? (kiellands)

Answer 3

No pelvic curve, enables a malpositioned head to be rotated to OA position

Question 4

What are the indications for instrumental delivery?

Answer 4

• Prolonged second stage (maternal exhaustion)
• Fetal distress
• Prophylactic use for pre-existing maternal medical problems
• Breech delivery

Question 5

What are the complications of instrumental delivery?

Answer 5

BOTH - Vaginal laceration and tears, more analgesia blood loss
VENTOUSE - Scalp lacerations, swelling and neonatal jaundice
FORCEPS - facial nerve damage, skull and neck fractures

Question 6

What is a low cavity vaginal delivery and what type of pain relief does it need?

Answer 6

When the head is well below the level of the ischial spines in OA position - this only requires a pudendal block or local anaesthesia

Question 7

What is a mid cavity vaginal delivery and what type of pain relief does it need?

Answer 7

When the head is not palpable abdominally and just at or below the level of the ischial spines in OA/OT/OP position - requires epidural or spinal anaesthesia