Instrumental Vaginal Birth Flashcards
What is an instrumental vaginal birth?
An instrumental vaginal birth involves using a device, such as forceps or a vacuum (ventouse), to assist the delivery of the baby.
What are the indications for an instrumental vaginal birth?
Indications include prolonged second stage of labour, fetal distress, maternal exhaustion, or maternal medical conditions (e.g., cardiac disease).
What are the two main instruments used in instrumental births?
The two main instruments are forceps and ventouse (vacuum).
What are the prerequisites for an instrumental vaginal birth?
Prerequisites include fully dilated cervix, engaged fetal head, ruptured membranes, empty bladder, and informed consent.
What is the role of maternal consent in instrumental vaginal birth?
Informed consent must be obtained, explaining the reasons, risks, benefits, and alternative options for delivery.
What is the difference between forceps and ventouse delivery?
Forceps use metal blades to grasp the fetal head, while ventouse uses a suction cup attached to the fetal scalp.
What are the types of forceps used in instrumental delivery?
Types include non-rotational forceps (e.g., Neville-Barnes forceps) and rotational forceps (e.g., Kielland’s forceps).
What are the contraindications for ventouse delivery?
Contraindications include preterm babies (<34 weeks), face presentation, suspected fetal bleeding disorders, and significant scalp oedema.
What are the complications of instrumental vaginal birth for the mother?
Maternal complications include perineal tears, vaginal trauma, haemorrhage, and increased risk of infection.
What are the complications of instrumental vaginal birth for the baby?
Neonatal complications include scalp injuries (e.g., cephalohaematoma, subgaleal haemorrhage), facial nerve injury, and jaundice.
How is fetal position assessed before an instrumental vaginal birth?
Fetal position is assessed by vaginal examination and confirmed with ultrasound if necessary.
What analgesia options are used for instrumental vaginal birth?
Options include epidural, spinal anaesthesia, or pudendal nerve block; local anaesthesia may also be used.
What is the purpose of an episiotomy during instrumental birth?
An episiotomy creates more space to facilitate delivery and reduce the risk of severe perineal tears.
What is the recommended duration for attempting instrumental delivery?
Delivery should be completed within 15-20 minutes to minimise risks to the mother and baby.
What is a failed instrumental vaginal birth?
A failed attempt occurs when the baby cannot be delivered safely with instruments, necessitating a caesarean section.
How is a ventouse cup applied?
The suction cup is placed on the flexion point of the fetal head (3 cm anterior to the posterior fontanelle) and vacuum pressure is applied.
What is the “three-pull rule” in ventouse delivery?
The “three-pull rule” limits the number of traction attempts to three to reduce risks of fetal injury.
What are the benefits of ventouse over forceps?
Ventouse is less likely to cause maternal trauma and does not require an episiotomy in all cases.
What are the benefits of forceps over ventouse?
Forceps can be used in more difficult deliveries, such as rotational deliveries, and provide a better grip on the fetal head.
What is the role of the obstetrician in instrumental delivery?
Obstetricians assess indications, ensure prerequisites are met, and perform the delivery using the appropriate instrument.
What is cephalohaematoma, and how is it related to ventouse delivery?
Cephalohaematoma is a collection of blood between the skull and periosteum, often associated with ventouse use.
What is subgaleal haemorrhage, and why is it a concern in ventouse delivery?
Subgaleal haemorrhage is a potentially life-threatening condition where blood accumulates between the scalp and periosteum.
How is neonatal jaundice linked to instrumental delivery?
Neonatal jaundice can result from bruising or cephalohaematoma caused by the use of forceps or ventouse.
What follow-up care is recommended after an instrumental vaginal birth?
Follow-up includes monitoring for maternal perineal trauma, neonatal injuries, and counselling if complications occurred.
What psychological impacts can instrumental vaginal births have on mothers?
Mothers may experience anxiety, trauma, or disappointment, requiring reassurance and support.
How does the presence of epidural anaesthesia influence the likelihood of an instrumental delivery?
Epidurals can increase the risk of instrumental delivery by reducing the mother’s ability to push effectively.
What is the importance of documentation in instrumental vaginal births?
Detailed documentation of the indication, procedure, instruments used, and outcomes is essential for legal and clinical purposes.
