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Appreciating Complex Midwifery Care > Instrumental Delivery > Flashcards

Instrumental Delivery Flashcards

1
Q

What are the 2 different types of forceps?

A
  • Low-cavity

- Mid-cavity

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2
Q

What are the 3 types of vacuum extraction?

A
  • Kiwi
  • Silicone rubber cup
  • Metal cup
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3
Q

Give 8 possible reasons for an instrumental delivery

A
  1. Delay in 2nd stage
  2. Prolonged 2nd stage
  3. Breech birth
  4. Multiple birth
  5. Foetal distress
  6. Obstetric emergency
  7. Malposition
  8. Elective (e.g. cardiac condition)
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4
Q

What should an assessment prior to an instrumental delivery include according to NICE (2014)?

A
  • The degree of urgency
  • Clinical findings
  • Anticipated degree of difficulty
  • Location
  • Need for additional analgesia/anaesthesia
  • Woman’s preferences
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5
Q

Give 7 contraindications of instrumental deliveries

A
  1. Unengaged head
  2. Malpresentation (face/brow)
  3. Inability to define position
  4. Large baby
  5. Inexperienced operator
  6. Less than 36/40 for vacuum extraction
  7. Less than 10cm dilation
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6
Q

What factors affect the decision of an instrumental delivery?

A
  • Presence/absence of foetal distress
  • Position and station
  • Maternal distress
  • Analgesia/anaesthesia
  • Skill of the operator
  • Equipment available
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7
Q

What should be used in an emergency situation?

A

Forceps is preferred as ventouse suction takes time to build up and comes off more easily

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8
Q

What should be used in a non-emergency situation?

A

Use whatever the practitioner is more comfortable with

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9
Q

What is the role of the midwife in an instrumental delivery?

A
  • 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
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10
Q

What is a pudendal block?

A

Pudendal nerves are blocked with the use of 0.5% lidocaine to provide local anaesthesia

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11
Q

Where should a ventouse cup be applied?

A

Over the flexion point approximately 3cm anterior to the posterior fontanelle and 6cm posterior to the anterior fontanelle

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12
Q

Give 4 neonatal risks of instrumental deliveries

A
  1. Cephalohaematoma
  2. Scalp abrasions
  3. Subdural haematoma
  4. Retinal haemorrhage
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13
Q

Which type of instrumental delivery poses more neonatal risks?

A

Ventouse

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14
Q

What are the 2 main maternal risks of instrumental deliveries?

A
  • Trauma (physical and psychological)

- Increased risk of PPH

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15
Q

Which type of instrumental delivery is more likely to fail at achieving a vaginal birth?

A

Ventouse

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16
Q

Give 2 neonatal complications of forceps deliveries

A
  1. Marks and bruising

2. Facial palsy due to pressure on facial nerve

17
Q

Give 3 maternal complications of forceps deliveries

A
  1. Soft tissue injuries (perineum, vagina, cervix)
  2. Damage to urethra
  3. Haemorrhage
18
Q

Is an episiotomy always required?

A
  • Advised more commonly with forceps

- Not an obligation for ventouse delivery

19
Q

When should an episiotomy not be performed?

A

If delivery is not imminent

20
Q

When should instrumental delivery be abandoned?

A
  • If there is no progressive descent with gentle traction

- If delivery is not imminent after 3 contractions

21
Q

Give some maternal postnatal complications

A
  • Anal sphincter injury/ perineal trauma
  • Risk of UTI/ other infection
  • DVT
  • Sexual problems
  • Acute trauma symptoms (PTSD)
  • PN depression
22
Q

Give some neonatal postnatal complications

A
  • Headache (analgesia?)
  • Irritable
  • Feeding problems
  • Eye problems
  • Attachment issues
  • Jaundice
23
Q

Give 4 reasons that may be given for litigation

A
  1. Failure in assessment
  2. Failure to perform CS
  3. Failure to seek senior help
  4. Inadequate documentation

Appreciating Complex Midwifery Care (14 decks)

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