Instrumental Delivery

Question 1

OUTLET FORCEPS - Wrigley’s forceps

Answer 1

• Used in Caesarean deliveries
• Used to lift fetus out when fetal scalp visible, skull has reached pelvic floor, rotation does not >45 degrees, can be OA/OP
• fetal head at perineum

Question 2

MID-CAVITY FORCEPS - Haig-Ferguson/Neville Barnes, Andersons, Simpsons

Answer 2

• Fetal head must be 0/5th palpable abdominally
• Station of head below ischial spines
• rotation <45 degrees

Question 3

ROTATIONAL FORCEPS - Kielland’s

*does not have pelvic curve unlike non-rotational forceps

Answer 3

• For rotation of fetus in OT/OP. Rotate to OA
• Requires competent user
• Complications: Infection, bleeding, fistulae, facial nerve palsy, bruising

Question 4

VENTOUSE(KIWI)

Answer 4

• Assisted delivery in any position
• Contraindications: cervix not fully dilated, fetus has bleeding disorder, not for premature fetuses
• Fetal head must be below ischial spine.

Question 5

PRERESQUISITES FOR VENTOUSE/FORCEPS:

Answer 5

1. Head not palpable abdominally
2. Head at/below ischial spines on vaginal examinations
3. Cervix fully dilated
4. Position of head known
5. Adequate analgesia
6. Valid indication for delivery
7. Empty bladder

Question 6

VENTOUSE VS FORCEPS:

Answer 6

For venotuse:

• higher failure rate
• more fetal trauma
• No difference in Apgar scores
• Less maternal trauma