Vacuum assisted vaginal delivery

Question 1

What indications for:

a) Simpson
b) Tucker Mclanes
c) Kielland
d) Piper

Answer 1

a) nullip, moulded head
b) multip, unmoulded head
c) rotation, lack pelvic curve, sliding lock
d) after coming head at breech delivery

Question 2

Reasons for vacuum pop off (7)

Answer 2

Rapid traction
Poor seal
Maternal tissue
No counter traction
Improper angle
Improper placement of cup (deflexion)
CPD

Question 3

What is the position for safety for forceps?

Answer 3

Posterior fontanelle (> 1 finger breath above shanks)
Fenestrations
Sagittal suture (perpendicular to shanks)

Question 4

Outlet forceps definition
Low forceps definition
Mid forceps definition

Answer 4

Oulet–> scalp on perineum, visible at introitus, head reaches pelvic floor

Low forceps–> leading part of skull is at >=2, < 45 or > 45

Mid forces–> 0+ higher, < 45 or > 45

Question 5

Contraindications to assisted vaginal delivery (6)

Answer 5

Lack of consent
Contraindications to vaginal delivery
face, brow presentation
unsure of position or station
preterm < 34 weeks (vacuum)(relative)
fetal issues (coagulopathy, demineralization disorder) 
cervical not fully dilated
unable to mount a C/S if failed operative delivery

Question 6

Indications for assisted vaginal delivery

Answer 6

Atypical/abnormal FHR
Maternal medical indications (cardiac, MS, spinal)
Maternal exhaustion
Correct acinclytism
Inadequate progress in second stage
At time of CS

Question 7

Cesarean section advised for vacuum (4)

Cesarean section advised for forceps (3)

Answer 7

2 pulls (with no descent)
3 pop-offs
4 contractions (with no imminent delivery)
20 minutes with no imminent delivery

Forceps:
unable to place blades
failure to rotate
no descent with one pull
3 traction with no imminent delivery

Question 8

Mediolateral episiotomy reduces OASIS in FAVD by

Answer 8

50%

Question 9

Risk factors that increase OASIS

Answer 9

Nullip
Previous OASIS
FHR abN requiring rapid delivery
Forceps

Question 10

assisted vaginal delivery can be reduced by (4)

Answer 10

continuous labour support
augmentation with IV oxytocin
delayed pushing with epidural
manual rotation of fetal head

Question 11

Maternal conditions requiring assisted vaginal delivery

Answer 11

spinal cord
cardiac
AVM
retinopathy
MG

Question 12

Risk factors associated with need for CS or need for operative delivery in OR

Answer 12

BMI >30
EFW >4000 g
Mid cavity
OP or OT

Question 13

Limitations to the Modified Robinson Criteria (1-10)

Answer 13

1) Unable to assess indications for cesaran section

2) unable to characteristics of pre-existing maternal or fetal disease

Question 14

Vacuum is associated with

Forceps is associated with

Answer 14

Vacuum

• higher rate of failure requiring C/S
• cephalohematoma
• retinal hemorrhage

Forceps

• less likely to fail
• Facial injury
• OASIS

Question 15

Accreta risk with:

1) previa and 1 previous C/S
2) previa and 2 previous C/S
3) Previa and >3 previous C/S

Accreta riks with
4) > =5 C/S

Answer 15

1) 11%
2) 40%
3) 61-67%

4) 7%