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OPERATIVE OBSTETRICS Part 01

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INDICATIONS FOR OPERATIVE VAGINAL DELIVERY 

  1. operative vaginal delivery is with forceps or vacuum extraction
  2. fetal

    • non-reassuring fetal status
    • consider if second stage is prolonged as this may be due to poor
      contractions or failure of fetal head to rotate

  3. maternal

    • need to avoid voluntary expulsive effort (cardiac/cerebrovascular disease)
    • exhaustion, lack of cooperation and excessive analgesia may
      impair pushing effort
FORCEPS

Low Forceps

  1. head visible between labia in between contractions
  2. often called outlet forceps
  3. sagittal suture in or close to A-P diameter
  4. rotation cannot exceed 45 degrees
Mid Forceps

  1. presenting part below spines but not yet visible at introitus
  2. not below 2+ spines
Types of Forceps

  1. Simpson forceps for OA presentations
  2. rotational forceps (Kjelland) when must rotate head to OA
  3. Piper forceps for breech
Absolute Prerequisites

  1. vertex, face or breech presentations
  2. fully dilated cervix
  3. empty bladder (risk of tear if full)
  4. adequate analgesia 
  5. ruptured membranes
  6. position and station are known
  7. presenting part below ischial spines
  8. experienced obstetrician
  9. pelvis of adequate size and shape
  10. uterine contractions present
  11. facilities to perform emergency C-section if needed



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VACUUM EXTRACTION

  1. traction instrument used as alternative to forcep delivery, aids
    maternal pushing
  2. same indications as forceps

Advantages
  1. easier to apply
  2. ess force on fetal head, less anesthesia required
  3. less maternal and fetal injury
  4. will dislodge if unrecognized CPD present

Disadvantages
  1. suitable only for vertex presentations
  2. maternal pushing required
  3. contraindicated in preterm delivery
OPERATIVE OBSTETRICS Part 01 OPERATIVE OBSTETRICS Part 01 Reviewed by Radiology Madeeasy on January 17, 2011 Rating: 5
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