Obs - Vacuum Extraction

Question 1

What would you assess before performing instrumental delivery?

Answer 1

Maternal condition: partogram and vitals

Fetal condition: CTG for heartrate and contraction, +/- fetal blood sampling

Indication: prolonged second stage, maternal exhaustion or underlying condition, fetal disress

Prerequisite:
Abd: longitudinal lie, head not palpable
PV: full dilatation, S+2, known head position cephaloc, ruptur of membrane, caput/excessive moulding

Question 2

Describe steps of ventouse delivery.

Answer 2

Rule out contraindications (cephalopelvic disproportion, bloodborn infection, coagulopathy)

1. Consent for vacuum, epi, emergency CS
2. Catheterise bladder
3. LA
4. Choose cup and connect to machine
5. Apply to flexion point 3cm anterior to posterior fontanelle over the sagittal fissure
6. Check no maternal tissue trapped
7. Suction force to 60 cmHg
8. Check no maternal tissue trapped
9. Traction in sync with uterine contraction and maternal effort (head descend with each pull, crown in 3 pulls, delivery in 5 pulls/15minutes)
10. Decide if episiotomy is needed when crowning
11. Give baby to neonatologist

Cord blood sampling, check for genital tract injury/PPH, debrief mother, documentation