Operative Vaginal Delivery Flashcards
2 types
Ventouse - vacuum
Kielland’s - forceps
Which type has a higher success rate but requires more skill?
Forceps
Indications:
Fetus - 1
Maternal - 4
Fetal distress
Prolonged 2nd stage of labour
Maternal exhaustion, often seen after 2 hours without progress in the 2nd stage
Unable to push
Medical avoidance of pushing (e.g. cardiac disease)
Criteria for use:
What presentation and engagement is needed?
What is needed to help make the woman comfortable to allow the obstetrician to perform safely?
Why does the bladder need to be emptied?
What about the cervix?
Cephalic and <1/5 engagement
Analgesia - pudendal or spinal block for mid-cavity rotation
Allows the fetal head to descend uninhibited. It is also helpful in case the forceps delivery fails, and an emergent cesarean section is necessary.
It needs to be fully dilated
Criteria for use:
What position must the baby be in for a ventouse (vacuum) delivery?
OA - occipito anterior
Process:
What position should the mother be put in and how is this done for her?
What may be needed to aid the passage of instruments - especially for forceps?
What does the obstetrician need to wait for before pulling?
How many attempts before a CS is done? Where can the procedure be done just in case this happens?
Lithotomy - stirrups
Episiotomy
Contractions - pull with every contraction - oxytocin might be needed
3 attempts - There may also be no delivery imminent after 3 attempts
Theatre or theatre prepared
Forcep types:
3 types - names of the following:
- Low cavity - W
- Mid cavity non-rotational - NB/S
- Mid cavity rotational - K
Wringleys
Neville-Barnes/Simpson’s
Kiellands
Ventouse (vacuum:
- How long does it take for the caput to resolve?
- Over what gestation must the baby be?
- Advantages over forceps - 1
- Disadvantages over forceps - 2
Name the 3 types
24-48 hrs
> 34 wks
Less genital tract trauma
More likely to cause fetal trauma
More likely to fail
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Metal cup
Soft cup
Kiwi OmniCup (a single-use with hand pump) ****
Complications:
The most common complication for mother
2 key fetal injuries:
Ventouse - Cephalohaematoma
Forceps - Facial nerve palsy
Info on back!
Other serious risks:
- Intracranial haemorrhage
Skull fracture
Spinal cord injury
Maternal perineal or vaginal trauma, especially with forceps - can lead to TEARS
A collection of blood between a baby’s scalp and the skull. Damaged blood vessels release the blood, and the blood pools into a mass under the skin of the scalp.
Rupture of the emissary veins, which are connections between the dural sinuses and the scalp veins. Blood accumulates between the epicranial aponeurosis of the scalp and the periosteum.- LOOKUP
Retinal haemorrhaging
Complications:
Fetal injuries with forceps (RARE):
- Palsy of what cranial nerve could happen?
- What else? - 3
OBPI is another complication.
- What does it stand for?
- What is it?
- Why does it happen?
CN 7 Facial nerve palsy
Skull fractures
Neonatal intracranial haemorrhage
Orbital injury
Obstetric brachial plexus injury
A flaccid paresis of an upper extremity due to traumatic stretching of the brachial plexus received at birth
