Operative and Twin Delivery

Question 1

What are the two most common causes of instrumental delivery

Answer 1

Fetal distress

Delayed second stage

Question 2

What must you be sure of before attempting instrumental delivery and how do you assess for it?

Answer 2

Being very aware of fetal position (particularly head position) is very important and so a lot of abdominal and vaginal palpation is important
The cervix must also be fully dilated, the head must be at the spines or below (>0), the bladder must be empt and analgesia satisfactory

Question 3

What are the two options for instrumental delivery?

Answer 3

Forceps or ventouse

Question 4

What are the different types of forceps?

Answer 4

NON-ROTATIONAL - applied over the baby’s head along the curvature of the spine and then downward and pulling traction applied along with uterine contractions
ROTATIONAL - used to rotate baby’s head from occipital-posterior to occipital-anterior. Rotation can be, and often is, tried manually first

Question 5

What are some benefits of ventouse over forceps?

Answer 5

Less pelvic space required, less analgesia, less maternal perineal trauma

Question 6

What are some benefits of forceps over ventouse?

Answer 6

More successful
Obstetrician favoured
Less cephalhaematoma or retinal haemorrhage

Question 7

At birth, how are twins usually orientated?

Answer 7

Cephalic/Cephalic (40%)
Cephalic/Breech (40%)
Breech/Cephalic (10%)
Other e.g. transverse (10%)

Question 8

When should multiple pregnancies be delivered?

Answer 8

Induce at 38-40 weeks but only if suitable for vaginal delivery (twin 1 has to be cephalic)
IF NOT then carry out a C/S at 38 weeks

Question 9

How do we monitor during twin deliveries?

Answer 9

Continuous monitoring is really important but it is equally important to make sure that when using a CTG we are not monitoring the same twin twice…
Therefore one twin (twin 2) is usually monitored using the CTG and the other (twin 1) is monitored using a fetal scalp electrode

Question 10

What measure should always be taken during twin delivery?

Answer 10

Obstetrician should always be present as well as a paediatrician, a midwife and an anaesthetist
Always have a syntocinon infusion ready just in case uterine activity decreases after the first delivery

Question 11

How do we deliver twin one and twin two?

Answer 11

Twin one should be delivered normally and after this it is often helpful to stabilise the lie of twin two as longitudinal by abdominal palpation
The membranes of twin two should NOT be broken until it descends into the pelvic cavity