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Instrumental vaginal delivery (Criteria (FORCEPS) (F: Fully dilated …
Instrumental
vaginal delivery
Indications
Maternal
Exhaustion
Prolonged 2nd stage (>1/2h passive and >1h pushing)
Valsalva CI (severe cardiac disease, HTN crisis, cerebral AVMs)
Unable to push (paraplegia/tetraplegia)
Foetal
Foetal compromise
Breech (control head)
Trial
Indication
Unsure of likelihood of success,
can progress immediately to EmCS
Failure
No progressive descent with each pull
Delivery not imminent following three pulls of instrument
Definition
Testing use of an instrumental delivery in
theatre when unsure of likelihood of success
Risk factors for failure
BMI>30
Large baby (EFW >4000g)
OP position of head
Head mid cavity (>1/5 palpable abdominally)
Types
Forceps
Complications
Maternal trauma (incl anal sphincter, spiral tears of vagina)
Foetal injury (facial nerve palsy, skull fracture, orbit injury, ICH)
Method
Curved blades sit around foetal head, allowing traction along flexion point of the head
Wrigley's, Neville-Barnes, Keillands
Use
Speed up delivery during contractions, or slow if breech
Correct malposition between contractions
Advantages and
disadvantages
Advantages
Speed up cephalic delivery
Slow down breech delivery
Less likely to cause foetal trauma
Disadvantages
Significant maternal genital tract trauma
Ventouse
Complications
Foetal injury (scalp lacerations, avulsions, cephalohaematoma,
retinal haemorrhage, ICH, long-term alopecia (rare)
Use
Speed up delivery during contractions
Method
Creates negative pressure, scalp sucked into cup
Creates artificial caput (chignon)
Atmospheric pressure on cup against negative pressure
keeps it in place
CI
<34w gestation
Advantages and
disadvantages
Advantages
Less likely to cause maternal trauma
Less CS deliveries
Disadvantages
More likely to cause foetal trauma (retinal haemorrhage, cephalohaematoma)
Maternal concerns about baby
Criteria
(FORCEPS)
F: Fully dilated
Cervix in 2nd stage
O: Obstruction
Exluded (head 1/5 palpable)
R: Ruptured membranes
SROM or AROM
2Cs: Catheterise, Check instruments
Catheter: in and out to drain, remove indwelling
Check:
check instrument
3Es: Explain, Epidural, Examine
Explain:
explain to patient, consent
Epidural: analgesia (or pudendal)
Examine: exclude genital tract trauma
4Ps: Presentation, Position, Power, Placement
Presentation:
of head
Position:
of head (for applying forceps
Power:
effective contractions (may need syntocinon)
Placement
forceps blades or ventouse
2Ss: Station, Senior help
Station:
station of presenting part
Must be below ischial spines
Senior help:
call for review
Epidemiology
10-15% of births
Definition
Use of instruments to assist
with childbirth (forceps/ventouse)