Instrumental Delivery Flashcards
What are the 2 different types of forceps?
- Low-cavity
- Mid-cavity
What are the 3 types of vacuum extraction?
- Kiwi
- Silicone rubber cup
- Metal cup
Give 8 possible reasons for an instrumental delivery
- Delay in 2nd stage
- Prolonged 2nd stage
- Breech birth
- Multiple birth
- Foetal distress
- Obstetric emergency
- Malposition
- Elective (e.g. cardiac condition)
What should an assessment prior to an instrumental delivery include according to NICE (2014)?
- The degree of urgency
- Clinical findings
- Anticipated degree of difficulty
- Location
- Need for additional analgesia/anaesthesia
- Woman’s preferences
Give 7 contraindications of instrumental deliveries
- Unengaged head
- Malpresentation (face/brow)
- Inability to define position
- Large baby
- Inexperienced operator
- Less than 36/40 for vacuum extraction
- Less than 10cm dilation
What factors affect the decision of an instrumental delivery?
- Presence/absence of foetal distress
- Position and station
- Maternal distress
- Analgesia/anaesthesia
- Skill of the operator
- Equipment available
What should be used in an emergency situation?
Forceps is preferred as ventouse suction takes time to build up and comes off more easily
What should be used in a non-emergency situation?
Use whatever the practitioner is more comfortable with
What is the role of the midwife in an instrumental delivery?
- Inform coordinator asap
- Informed consent
- Pain relief
- Bladder care
- Get into lithotomy
- Active management of 3rd stage
- Neonatal resus equipment prep
- Documentation
- Communication with mother
What is a pudendal block?
Pudendal nerves are blocked with the use of 0.5% lidocaine to provide local anaesthesia
Where should a ventouse cup be applied?
Over the flexion point approximately 3cm anterior to the posterior fontanelle and 6cm posterior to the anterior fontanelle
Give 4 neonatal risks of instrumental deliveries
- Cephalohaematoma
- Scalp abrasions
- Subdural haematoma
- Retinal haemorrhage
Which type of instrumental delivery poses more neonatal risks?
Ventouse
What are the 2 main maternal risks of instrumental deliveries?
- Trauma (physical and psychological)
- Increased risk of PPH
Which type of instrumental delivery is more likely to fail at achieving a vaginal birth?
Ventouse
Give 2 neonatal complications of forceps deliveries
- Marks and bruising
2. Facial palsy due to pressure on facial nerve
Give 3 maternal complications of forceps deliveries
- Soft tissue injuries (perineum, vagina, cervix)
- Damage to urethra
- Haemorrhage
Is an episiotomy always required?
- Advised more commonly with forceps
- Not an obligation for ventouse delivery
When should an episiotomy not be performed?
If delivery is not imminent
When should instrumental delivery be abandoned?
- If there is no progressive descent with gentle traction
- If delivery is not imminent after 3 contractions
Give some maternal postnatal complications
- Anal sphincter injury/ perineal trauma
- Risk of UTI/ other infection
- DVT
- Sexual problems
- Acute trauma symptoms (PTSD)
- PN depression
Give some neonatal postnatal complications
- Headache (analgesia?)
- Irritable
- Feeding problems
- Eye problems
- Attachment issues
- Jaundice
Give 4 reasons that may be given for litigation
- Failure in assessment
- Failure to perform CS
- Failure to seek senior help
- Inadequate documentation
