Operative Vaginal Delivery Flashcards
What is an operative vaginal delivery?
The use of an instrument to aid delivery of the fetus
It occurs in what percentage of births in the UK?
10-15%
What instrument types are there?
Forceps
Ventouse
Forceps have a lower risk of fetal or maternal complications?
Lower risk of fetal complications and higher risk of maternal complications
Describe forceps
Curved blades designed to fit around the fetal head, allowing traction to be applied via handles
Require much less maternal effort for successful delivery than ventouse, so less likely to fail
The general rule is after …contractions and pulls with any instrument and there is no reasonable progress, the attempt should be abandoned
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What is a ventouse?
An instrument that attaches a cup to the fetal head via a vacuum
- silastic cup (only if fetus in occipital-anterior position)
- kiwi (can be used for all fetal positions)
During contractions, traction applied perpendicular to cup
The ventouse cup is applied where?
It’s centre over the flexion point on fetal skull - 3cm anterior to posterior fontanelle
Ventouse deliveries are associated with…
Lower success rate Less maternal perineal injuries Less pain More cephalhaematoma More subgaleal haematoma More fetal retinal haemorrhage
What maternal indications are there for operative vaginal delivery?
Prolonged second stage for any reason
Maternal exhaustion
Medical avoidance of pushing - severe cardiac disease, intracranial pathologies, severe HTN
What fetal indications are there for operative vaginal delivery?
Suspected fetal distress - diagnosed usually by CTG or abnormal fetal blood sample
For the after coming head in a breech delivery
What contraindications are there to instrumental delivery?
Unengaged fetal head in singleton pregnancy
Incompletely dilated cervix in singleton pregnancy
True cephalo-pelvic disproportion
Breech, face and most brow presentations (forceps can be used for after coming head in complex breech)
Preterm gestation <34w for ventouse
High likelihood of any fetal coagulation disorder for ventouse
What maternal complications can occur with operative deliveries?
Maternal genital tract trauma - especially with forceps
Spiral vaginal tears with rotational forcep delivery
VTE
Incontinence
PPH
Shoulder dystocia
Infection
What fetal complications can occur with ventouse?
Cephalhaematoma
Retinal haemorrhage
Scalp lacerations and avulsions
What fetal complications can occur with forceps?
Facial nerve palsy
Skull fractures
Orbital injury
