Obs - instrumental and operative delivery

Question 1

list the complications of instrumental delivery?

Answer 1

Maternal:
vaginal lacerations
Blood loss
Third degree tears

Fetal:
Scalp lacerations 
Cephalhaematoma 
Neonatal jaundice 
Facial bruising
Facial nerve damage 
Skull and neck fractures

Question 2

When is instrumental delivery indicated?

Answer 2

1. Prolonged second stage
   o 1h of pushing has failed to deliver
2. Fetal distress
3. Prophylactic use in women with cardiac disease or htn
4. In a breech delivery

Question 3

How would you go about a low or middle cavity instrumental delivery?
How would you manage: OA, OT, OP

Answer 3

Low station is +2cm:
Forcep or ventouse
 Forceps better if maternal effort is poor
 Pudendal block with perineal infiltration = sufficient analgesia

Middle (1/5ths palpable abdominally):
Forcep or ventouse
Baby may be OA, OT, OP

High cavity:
instrumental not recommended. weight for descent?

 OA: forceps or ventous
 OT: descent achieved with ventouse, non-rotational forceps contraindicated
 OP: accompanied by extension of fetal health
o Kielland’s forceps to rotate baby 180 degrees

Note; cant do ventouse before 34wks

Question 4

What are the absolute and relative indications for elective section?

Answer 4

Absolute indications
o Placenta praevia
o Severe antenatal fetal compromise
 o Uncorrectable abnormal lie
o Previous vertical CS
o Gross pelvic deformity

 Relative indications
 o Breech
o Severe IUGR
o DM
o Twins
o Other medical disease o Previous CS
o Older nullips

 If delivery is <34 weeks, usual to perform a CS rather than induce labour
o PET/Severe IUGR