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

• Maternal pushing is contraindicated (e.g. severe cardiac disease, severe hypertension)
• Fetal distress
• Inadequate maternal effort
• Vaginal breech delivery

Question 3

Prerequisites for instrumental delivery

Answer 3

1. Abdominal exam: head not palpable (fully engaged)
2. PV exam:
   
   • Fully dilated cervix with membrane rupture
   • Station +1 or lower
   • No significant caput / excessive moulding (signify obstructed labour)
3. Rule out other contraindications:
   
   • Fetal bleeding tendency, maternal ITP
   • Maternal infection
   • Macrosomia, GDM
4. Procedural preparation:
   
   • Explanation of procedures & maternal consent
   • Aseptic techniques
   • Empty bladder
   • Analgesia (LA for vacuum, pudendal block for forceps)
     +/- Episiotomy (must for forceps)

Question 4

Neonatal complications of vacuum delivery

Answer 4

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