INDICATIONS FOR OPERATIVE VAGINAL DELIVERY operative vaginal delivery is with forceps or vacuum extraction fetal non-reassuring f...
INDICATIONS FOR OPERATIVE VAGINAL DELIVERY
- operative vaginal delivery is with forceps or vacuum extraction
- 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 - maternal
- need to avoid voluntary expulsive effort (cardiac/cerebrovascular disease)
- exhaustion, lack of cooperation and excessive analgesia may
impair pushing effort
Low Forceps
- head visible between labia in between contractions
- often called outlet forceps
- sagittal suture in or close to A-P diameter
- rotation cannot exceed 45 degrees
- presenting part below spines but not yet visible at introitus
- not below 2+ spines
- Simpson forceps for OA presentations
- rotational forceps (Kjelland) when must rotate head to OA
- Piper forceps for breech
- vertex, face or breech presentations
- fully dilated cervix
- empty bladder (risk of tear if full)
- adequate analgesia
- ruptured membranes
- position and station are known
- presenting part below ischial spines
- experienced obstetrician
- pelvis of adequate size and shape
- uterine contractions present
- facilities to perform emergency C-section if needed
.
VACUUM EXTRACTION
- traction instrument used as alternative to forcep delivery, aids
maternal pushing - same indications as forceps
Advantages
- easier to apply
- ess force on fetal head, less anesthesia required
- less maternal and fetal injury
- will dislodge if unrecognized CPD present
Disadvantages
- suitable only for vertex presentations
- maternal pushing required
- contraindicated in preterm delivery
