Intrapartum Care - Instrumental Delivery

Question 1

What is Instrumental Delivery?

Answer 1

Vaginal delivery assisted either by a Ventouse Suction Cup or Forceps (tools to help deliver the baby’s head).

Question 2

What is recommended after Instrumental Delivery?

Answer 2

Co-Amoxiclav to reduce risk of maternal infection.

Question 3

Indications of Instrumental Delivery (5).

Answer 3

1. Failure to Progress (2nd Stage).
2. Foetal Distress (2nd Stage).
3. Maternal Exhaustion (2nd Stage).
4. Control of the Head in Various Foetal Positions.
5. Increased Risk with Epidural.

Question 4

Maternal Risks of Instrumental Delivery (6).

Answer 4

1. PPH.
2. Episiotomy.
3. Perineal Tears.
4. Injury to Anal Sphincter.
5. Urinary/Faecal Incontinence.
6. Nerve Injury (Obturator/Femoral).

Question 5

Prognosis of Nerve Injury.

Answer 5

Resolves over 6-8 Weeks.

Question 6

Aetiology of Femoral Nerve Injury.

Answer 6

Compression against Inguinal Canal during Forceps Delivery.

Question 7

Clinical Features of Femoral Nerve (3).

Answer 7

1. Weakness of Knee Extension.
2. Loss of Patellar Reflex.
3. Numbness of Anterior Thigh and Medial Lower Leg.

Question 8

Aetiology of Obturator Nerve Injury (2).

Answer 8

1. Compression by Forceps Delivery.

2. Compression by Foetal Head during Normal Delivery.

Question 9

Clinical Features of Obturator Nerve Injury (2).

Answer 9

1. Weakness of Hip Adduction and Rotation.

2. Numbness of Medial Thigh.

Question 10

Foetal Risks of Instrumental Delivery (4).

Answer 10

1. Subgaleal Haemorrhage (most dangerous).
2. Intracranial Haemorrhage.
3. Skull Fracture.
4. Spinal Cord Injury.

Question 11

Specific Foetal Risks of Instrumental Delivery (4).

Answer 11

1. Ventouse - Cephalohaematoma (collection of blood between skull and periosteum).
2. Forceps - Facial Nerve Palsy (facial paralysis).
3. Forceps - Bruises.
4. Fat Necrosis - Lumps of Fat on Cheeks (resolve spontaneously).

Question 12

What is Ventouse?

Answer 12

A suction cup on a cord - the cup on the baby’s head; the cord with applied careful traction to pull the baby out.

Question 13

What is Forceps?

Answer 13

Metal tongs that grip the head which is used to pull the baby out.

Question 14

Nerve Injuries Unrelated to Instrumental Injury (3).

Answer 14

1. Lateral Cutaneous Nerve of the Thigh.
2. Lumbosacral Plexus.
3. Common Perineal Nerve.

Question 15

Aetiology of Lateral Cutaneous Nerve of the Thigh Palsy.

Answer 15

Prolonged flexion at the hip while in the lithotomy position - runs under the inguinal ligament = numbness of anterolateral thigh.

Question 16

Aetiology of Lumbosacral Plexus Palsy.

Answer 16

Compression of the foetal head during Second Stage of Labour = foot drop and numbness of anterolateral thigh, lower leg and foot.

Question 17

Aetiology of Common Perineal Nerve Palsy.

Answer 17

Compression on the head of the fibula whilst in the lithotomy position - foot drop and numbness in the lateral lower leg.