OPERATIVE VAGINAL DELIVERY Dr Jina khalid mohammed fadl

OBJECTIVES: By the end of the session the candidate should be able to :

DEFINITION � It is delivery in which the operator uses instrument in order to

INDICATIONS v Maternal : � Prolonged second stage of labour. � Maternal exhaustion �

PREREQUISITE � No CPD. � Cx fully dilated. � Ruptured Membranes. � Bladder empty.

CONTRAINDICATIONS Preterm baby <34 wks (vacuum extractor ). � Fetal blood sampling � CPD.

TYPES OF FORCEPS. � Outlet forceps. � Rotational forceps. � Long curved forceps.

PROCEDURE � ABCDEFGHIJ appraoch for ventouse. � A: ask for help, address the pt,

� F: flexion point 3 cm ant to post font � G : gentle

� I: � J: incision for episiotomy. release vaccum after appearance of the jaw.

� ABCDEFGHIJ � A: approach forceps. ask for help, address the pt, adequate analgesia

� F: forceps : right pair, articulation. � G: gentle traction with contraction. �

COMPLICATION : � Failure of the procedure. � Maternal: Injuries Perineal Injury (extension of

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OPERATIVE VAGINAL DELIVERY. Dr. Jina khalid mohammed fadl

Expectations? ? ?

OBJECTIVES: By the end of the session the candidate should be able to : Ø define operative vaginal delivery. Ø enumerate : � Types of the operative V. D. � The parts of each instrument. � Types of forceps. Ø Describe indications, contraindications, prerequisite. Ø To practice procedure according to ALSO approach Ø

DEFINITION � It is delivery in which the operator uses instrument in order to help baby to pass for extra uterine life.

1 - FORCEPS. 2 -VACUUM EXTRACTOR.

INDICATIONS v Maternal : � Prolonged second stage of labour. � Maternal exhaustion � Maternal diseases (cardiac , resp) v Fetal : � Fetal distress. � After coming head of the breech. � Malposition.

PREREQUISITE � No CPD. � Cx fully dilated. � Ruptured Membranes. � Bladder empty. � Vertex presentation. � Engaged head.

CONTRAINDICATIONS Preterm baby <34 wks (vacuum extractor ). � Fetal blood sampling � CPD. � Cx not fully dilated � Breech , shoulder, face (vacuum). �

TYPES OF FORCEPS. � Outlet forceps. � Rotational forceps. � Long curved forceps.

PROCEDURE � ABCDEFGHIJ appraoch for ventouse. � A: ask for help, address the pt, adequate analgesia. � B: Empty bladder. � C: Cx fully dilated. � D: Determine position, , shoulder dystocia � E: Equipments(Extractor, neonatal resuscitation, episiotomy)

� F: flexion point 3 cm ant to post font � G : gentle traction with contraction. � H : Halt traction in 3 situations : 3 pop offs. 20 min since start of procedure. No progress after 3 consecutive contraction.

� I: � J: incision for episiotomy. release vaccum after appearance of the jaw. Then continue delivery of the remainder of the body, suture incision, check for maternal injuries & then document whole procedure.

� ABCDEFGHIJ � A: approach forceps. ask for help, address the pt, adequate analgesia � B: Empty bladder. � C: Cx fuly dilated. � D: determine position, Think of shoulder dystocia.

� F: forceps : right pair, articulation. � G: gentle traction with contraction. � H: Handle elevation. � I : Incision for episotomy. � J: disarticulate after appearance of the jaw. Then continue delivery of the remainder of the body, suture incision, check for maternal injuries & then document whole procedure.

COMPLICATION : � Failure of the procedure. � Maternal: Injuries Perineal Injury (extension of episiotomy). Vaginal and Cervical laceration. ---PPH. � Fetal : Cephalohaematoma , intracranial haemorhage, facial palsy , brachial plexus injury. � Facial & forehead injuries.

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