Flashcards in Assisted Vaginal Delivery & Perineal Injury Deck (13):
What are the indications for assisted delivery? (categorise)
-Inadequate expulsion efforts (Neuromuscular/spinal cord injury)
-Need to avoid maternal expulsion effort (cardiac/cerebrovascular disease)
-Prolonged stage 2 of labour:
Nulliparous = > 2hours
Multiparous = >1 hour
Note: if with regional analgesia increase by 1hr before abnormal
What are the requirements which must be met before assisted delivery can be undertaken?
Vertex presentation and engaged
Cervix fully dilated
No placenta previa
Note, placenta previa = a condition in which the placenta partially or wholly blocks the neck of the uterus, so interfering with normal delivery of a baby.
What are the different classifications of forceps and give examples?
Classic forceps which have a pelvic or cephalic curvature:
Rotational forceps which allow rotation to the OA position:
Forceps designed to assist breech delivery:
What are the potential complications associated with forceps delivery?
Increased maternal trauma (including anal sphincter)
Rotational forceps often cause vaginal tears
Inter cranial haemorrhage
What are the potential complications associated with Ventouse delivery?
Ventouse = suction
Temporary swelling on the head (chignon)
Rarely inter cranial haemorrhage
What factors play a decision in the type of assisted delivery?
Position and descent of the head.
If head is OT/OP use either Kielland forceps or ventouse.
If the head is at or just below the IS aka station 0/+1 mother will need an epidural and spinal and there must be a theatre ready in case a emergency CS is needed.
What factors are predisposing for needing an assisted delivery?
An induced labour
What are the risk factors for a failed assisted delivery?
Estimated fetal weight >4kg
Mid cavity delivery/head is > 1/5 palpable abdominally
What is an episiotomy, what are the different types?
A surgical incision into the perineum to facilitate delivery.
Can be done by 2 incisions:
Mediolateral: Incision at 45 degree to the posterior forchette. Less perineal trauma but antidotally increase blood loss, wound infection and pain.
Midline: Vertical midline incision from the posterior forchette to the rectum. Associated with increased perineal trauma involving the anal sphincters.
What are the indications for episiotomy?
Breech if not going CS
Assisted delivery (forceps/ventouse)
Extensive lower genital tract scarring
Poorly healed 3/4th degree tears
What are the complications of episiotomy?
Bleeding and haematoma
Dyspareunia (painful sex)
Rarely fistula formation
What are the different classifications of perineal tear?
1st degree: Vaginal mucosa
2nd degree: Subcutaneous tissue
3rd degree: External anal sphincter involvement
4th degree: Internal anal sphincter involvement