Assisted vaginal delivery Flashcards
(9 cards)
Indications for assisted vaginal delivery
labour - prolonged second stage
foetal - suspected foetal compromise (pathological CTG, abnormal FBS, thick meconium)
- to assist delivery of aftercoming head of a breech
maternal - exhaustion
- shorten and reduce effects of second stage in women with medical conditions (cardiac, hypertensive crisis, myasthenia gravis, spinal cord injury)
Cautions in assisted vaginal delivery
vacuum contraindicated <32/40 (caution 32-36/40)
foetal bleeding disorders
foetal fracture risk
blood borne viral infection
Pre-requisites for assisted vaginal delivery
FORCEPS
Fully dilated
0/5 palpable or Only 1/5 palpable
Ruptured membranes
Contractions, Consent
Empty bladder
Presentation - vertex, Position - known
Station - at spines or below, Satisfactory analgesia
Which factors indicate a higher risk of failure of assisted vaginal delivery?
BMI>30
short maternal stature
EFW>4kg
occipito-posterior position
mid-cavity or >1/5 palpable per abdomen
Complications of assisted vaginal delivery
failure
baby - shoulder dystocia, neonatal trauma
mother - perineal trauma, cervical trauma, haemorrhage, psychological morbidity
What is classed as failure of assisted vaginal delivery?
3x detachments of vacuum cup
forceps blades cannot be applied easily
no evidence of progressive descent
delivery not imminent after 3 pulls of instrument
Shoulder dystocia causes
high BMI
maternal diabetes
foetal macrosomia
labour dystocia
slow delivery of head
lack of restitution
turtling of head
What neonatal trauma can occur post-assisted vaginal delivery?
bruising
swelling
facial or scalp lacerations
cephalohaematoma
retinal haemorrhage
subgaleal haemorrhage
intracranial heamorrhage
skull fracture
facial nerve palsy
Recommended episiotomy location
mediolateral episiotomy
directed towards right side
