Operative Delivery

Question 1

What is valsalva?

Answer 1

It is forced exhalation against a closed airway

Test cardiac function and autonomic control of the heart, or clear ear and sinuses

Question 2

What are the indications for operative vaginal delivery for:

Nulliparous women

Multiparous women

Answer 2

Nulliparous women - lack of continuing progress for 3 hours with regional anaesthesia; or 2 hours without anaesthesia

Multiparous women - lack of continuing progress for 2 hours with regional anaesthesia; or 1 hour without anaesthesia

Question 3

What are the requirements for instrumental delivery?

Answer 3

Valid reason

Head not palpable (abdominally)

Head must be at/below level of ischial spines

Cervix dilated

Position of foetal head known

Adequate Analgesia

Bladder empty

Must have facilities to perform C-section in case of failure

Question 4

What is a ventouse and how is it used?

Answer 4

It is a cap fixed 2-3cm anterior to the posterior fontanelle (flexion point) by suction

Question 5

What are the names of the rotational and non-rotational forceps?

Answer 5

Non-rotational = Neville-Barnes

Rotational = Kiellands

Question 6

What is this?

Answer 6

Kiellands forceps - Rotational

Question 7

What is this?

Answer 7

Neville Barnes - with pelvic curve, non-rotational

Question 8

What should be used for instrumental delivery when the foetal head is the following positions?

occipito-anterior

occipito-transverse

occipito-posterior

Answer 8

Occipito-anterior: Forceps or Ventouse

Occipito-transverse: Usually due to insufficient dsecent of head to cause rotation

• Ventouse to achieve descent and hopefully rotation
• Rotational forceps to achieve rotation in situ → descent

Occipito-posterior: Often + extension of foetal head → presenting part too large

• Aim for rotation of 180^o with ventouse/rotational forceps

Question 9

Which complications are associated to each method, ventouse and forceps?

Answer 9

Ventouse more dangerous in general, Forceps only more dangerous for perineal and vaginal trauma

Equal likelihood of delivery by C-section, low 5-minute APGAR, need for phototherapy

Question 11

When is operative vaginal delivery stopped?

Answer 11

• No evidence of progressive descent with each pull
• Delivery is not imminent following three pulls of correctly applied instrument by experienced operator

Question 12

What proportion of babies are delivered by caesarean section in the developed world?

Answer 12

20-30%

Question 13

What are the absolute indications for emergency C-section?

Answer 13

Placenta praevia

Severe antenatal fetal compromise

Uncorrectable abnormal lie

Previous classical C-section

Pelvic deformity

Question 14

What are relative indications for emergency C-section?

Answer 14

Breech presentation

DM and other medical diseases

Previous C-sections

Older nulliparous women

Question 15

When is an emergency C-section indicated before 34 weeks

Answer 15

Severe pre-ecampsia

Severe intrauterine growth restriction

Question 16

What type of inscision is made in a C-section?

Answer 16

Pfannesteil incision - horizontal (skin)

Lower segment ceasarean section (uterus)

Other incisions: Vertical (skin), Classical (uterus)