Instrumental Delivery

Question 1

What are the indications for instrumental delivery

Answer 1

• maternal: distress\exhausted - CVD\Pulmonary - prolonged 2nd stage
• fetal: distress -preterm - breech delivery

Question 2

What are prerequisites of instrumental delivery

Answer 2

1- engaged head, known position of head\attitude.
2- evaluated pelvis, emptied bladder, dilated cervix
3- analgesia\consent\skill\ backup plan

Question 3

Define engagement:

Answer 3

Passage of the largest diameter of the presenting part in (inlet)

• cephalic: biparital
• breech: bi-trochantric

Question 4

What is the position and attitude of the head

Answer 4

• position: occipto (ant, post,transverse)

- attitude: flexed, extended or hyperextended

Question 5

What is the favorable head position and attitude

Answer 5

Position: occipitoanterior
Attitude: flexed

Question 6

Why does the cervix have to be dilated when using instrument

Answer 6

To avoid injury and laceration to the cervix

Question 7

What do we mean by backup plan in instrumental delivery

Answer 7

Going to c-section

Never use two instruments at the same time

Question 8

What are the absolute contraindications in instrumental delivery

Answer 8

1-lack of engagement & high head (unable to diagnose position)
2- CPD
3- malpresentation
4- unable to apply instrument

Question 9

What are the relative contraindications in instrumental delivery

Answer 9

1- Macroscomia\CPD
2- higher station
3- proficiency and experience

Question 10

What are the types of instruments?

Answer 10

1- vacuum extractor

2- forceps

Question 11

What is the currently vacumm extractor

Answer 11

Kiwi (doesnt need to be connected to electricity, handy and less traumatic)

Question 12

How to choose between forceps and vacumm?

Answer 12

Foreceps: traction + rotation
Vacumm: traction

Question 13

What is the technique for using the vacum

Answer 13

1- patient is dilated 
2- head flexed 
3- push during contraction 2x force 
4- after release remove the vacumm
5- episiotomy

Question 14

What are the parts of forceps in instrumental delivery

Answer 14

1- toe, blade, shanck, lock & handle

2- cephalic and pelvic curve

Question 15

Sphincter defects are more common with

Forceps or vacuum

Answer 15

Foreceps

Question 16

Cephalhematoma are more common with

Forceps or vacuum

Answer 16

Vacum

Question 17

What is a serious, and rare complication of using forceps

Answer 17

Intracranial hemorrhage

Question 18

Which one is more likley to have more failure rates?

Forceps or vacuum

Answer 18

Vacumm

Question 19

What are the complications of using instrumenst?

Answer 19

1- sphincter defect
2- cephalhematoma and intracranial hemorrhage
3- cervical\vagina\uterine tears
4- bladder\uretheral\rectal injury
5- fetal fascial palsies\or brachial plexus
6- fistula\postpartum urinary retention

Question 20

Why is the maternal morbidity associated with CS is more than mortality associated with vaginal delivery?

Answer 20

1- infection
2- hemorrhage
3- thromboembolism

Question 21

What are the indications of CS?

What are the absolute ones

Answer 21

1- dystocia
2- prev. CS (2 or 3)
3- fetal distress
4- (breech)

ABSOLUTE:

• footling presentation
• Full thickness, non-transverse, incision in myometrium

Question 22

Why is repeat C\S is an indication for C\s

Answer 22

To avoid uterine rupture

Question 23

What are the avoided incision in C\S

Answer 23

Classical and low vertical C\S

Question 24

Why are classical and low vertical C-sections are to be avoided?

Answer 24

Because high vascular are and very difficult to repare

Question 25

What is the most commonly used CS?

Answer 25

The low transverse

Question 26

When do we go for low vertical suture in C\S?

Answer 26

In preterm delivery because the lower segment is not formed yet (before 36w)

Question 27

What is important to be done in low transverse C\S

Answer 27

Do bladder flap to

Question 28

How to reduce the risk of C\S?

Answer 28

-By external cephalic version of breech
(From 36-37w)
- By VBAC