OBS: Perinatal Medicine -- Instrumental Delivery

Question 1

Neonatal complications of forceps delivery

Answer 1

• Facial palsy
• Skull fracture
• Intracranial haemorrhage
• Face abrasions

Question 2

Indications of instrumental delivery

Answer 2

1. Emergency situation (e.g. fetal distress)
2. Inadequate maternal pushing effort → prolonged 2nd stage of labour
3. Maternal effort is prohibited (e.g. cardiovascular diseases)

Question 3

Pre-operative assessment and preparation for instrumental delivery

Answer 3

1. Hx review
2. Abdominal exam: fetal head not palpable
3. PV exam:
   
   1. Cervical dilatation
   2. Fetal head station
   3. Fetal head position
   4. Fetal head asynclitism
   5. Fetal head moulding & caput
   6. Maternal pelvis (for any contracted pelvis)
4. Preparation: CACACL
   
   1. Consent
   2. Aseptic technique
   3. Catheterize urinary bladder then remove Foley
   4. Pudendal anaesthesia
   5. Choose appropriate forceps / vacuum cups & check if they are lockable
   6. Lubricate the forceps / vacuum cups

Question 4

Neonatal complications of vacuum delivery

Answer 4

• Chignon
• Cephalohaematoma
• Subaponeurotic haematoma
• Intracranial haemorrhage
• Fetal skull fracture