Instrumental/Operative Delivery Flashcards
what % of women deliver babies using instruments
20%
what is a ventouse
suction cup attached to a stick allowing assisted forces for delivery
what are the two types of forceps
Non-rotational (simpsons)
Only suitable for OA
Grip the head whatever position it is in and applies tractional force
Have a cephalic curve for the head and a pelvic curve which follows the sacral curve
Rotational (keillands)
No pelvic curve
Allows a malrotated head to be rotated to OA position before traction is applied
what are the foetal complications with assisted delivery
Slightly worse with ventouse
Chignon (swelling where cap was placed) is usual
Cephalohaematoma (doesn’t cross suture lines)
Neoatal jaundice
Scalp lacerations
Forceps may cause facial bruising, CNVII damage or skull fractures
Prolonged traction by either is dangerous
what is the defining characteristic of a cephalohaematoma
swelling caused by ventouse, not crossing suture lines
what are maternal complications of instrumental delivery
Increased requirement for analgesia
Post-partum haemorrhage
3rd degree tears
Vaginal lacerations
whats is the policy around changing instruments during assisted labour
Associated with increased foetal trauma and therefore is never used unless there is one situation
If ventouse gets the baby to the pelvic outlet but the cap falls off, it is replaced by forceps
what are indications for an instrumental delivery
Prolonged 2nd stage
1-2 hours of pushing and no delivery
Foetal distress
Prevent pushing in women with issues with medical problems
(Severe cardiac disease, Hypertension )
Breech
The caveat to using these instruments is that if they do not provide at least a modest effect C-section is indicated
what are the requirements before instrumental delivery is performed
Head is not palpable abdominally
Head must be at or below the level of the ischial spines
Cervix must be fully dilated
Position of the head must be known
Adequate analgesia
Bladder should be empty
what are features of a low cavity delivery
Head well below ischial spines
Usually OA
Forceps or ventouse are appropriate
Pudendal block sufficient analgesia
what is a mid-cavity delivery and how do you manage a one with instruments
Head is engaged but at or just below the level of the ischial spines
Epidural/spinal anaethesia used
Any doubts = delivery in theatre in view of doing a c section at any point
OA position – forceps or ventouse
OP position – ventouse/keillands forceps are used to rotate the head 180 degrees, direct tractional force is not applied as its more likely to fail or if it succeeds there is a severe risk of perineal trauma
OT position (occipito-transverse) - usually due to insufficient descent so the ventouse is more commonnly used to descend the head down
what % of births are C-section
25%
what are the indications for an emergency C section
If full dilation is not achieved by 12-16 hours, or earlier if the patient has a history of quick first stage (prolonged first stage)
Or if the patient is fully dilated but all the criteria for instrumental delivery aren’t met
Foetal distress (as seen on CTG/blood sampling)
what are the indications for elective c-sections
Absoloute: Placental praevia Severe foetal antenatal compromise Previous vertical C section Uncorrectable abnormal lie Gross pelvic abnormality
Relative: Breech Severe IUGR Twins Certain medical disorders Previous C-section Older nulliparous patients <34 week delivery
what are the maternal complications of a c-section
VTE
Visceral damage (uterus/bladder)
Haemorrhage
Need for transfusion
Infection
Post-op pain and immobility
