PB 219: Operative Vaginal Birth

Question 1

Indications for operative vaginal delivery (3)

Question 2

Criteria for Types of Forceps Deliveries

Answer 2

1. Outlet forceps
   
   1. Fetal scalp is visible at introitus without separate labia
   2. Fetal skull has reached pelvic floor
   3. Fetal head is at or on perineum
   4. Sagittal suture is in an AP diameter or ROA or LOA position
   5. Rotation does not exceed 45 degrees
2. Low forceps
   
   1. Leading point of fetal skull is at station +2 cm or more and not on pelvic floor
   2. Without rotation: Rotation is 45 degrees or less
   3. With rotation: Rotation is greater than 45 degrees
3. Mid forceps
   
   1. Station is above +2 cm but head is engaged

Question 3

Prerequisites for Operative Vaginal Birth

Answer 3

• Cervix fully dilated and retracted
• Membranes ruptured
• Engagement of fetal head
• Position of fetal head has been determined
• EFW
• Adequate pelvis
• Adequate anesthesia
• Maternal bladder emptied
• Patient has agreed after being informed of risks/benefits
• Willingness to abandon trial of operative vaginal birth and back-up plan in place in case of failure to deliver

Question 4

Placement of vacuum

Question 5

Maternal Complications of Operative Vaginal Birth

Answer 5

Forceps delivery appears to have higher risk of anal sphincter injury

Question 6

Newborn Complications of Operative Vaginal Birth

Answer 6

Vacuum:

1. Intracranial hemorrhage (1 in every 750 operative vaginal deliveries)
2. Scalp laceration
3. Cephalohematoma formation

Forceps:

1. Intracranial hemorrhage
2. Facial lacerations
3. Facial nerve palsy
4. Corneal abrasions and external ocular trauma
5. Skull fracture

Question 7

What are the contraindications to operative vaginal delivery?

Answer 7

1. Fetal head unengaged
2. Position of fetal head unknown
3. Strong suspicion to have bone demineralization condition (e.g. osteogenesis imperfecta)

Question 8

Should prophylactic antibiotics be administered at the time of operative vaginal birth?

Answer 8

No, consider if third or fourth degree laceration noted