OPERATIVE VAGINAL

DELIVERY
CESAREAN SECTION
REVIEW
WHAT IS AN OPERATIVE
VAGINAL DELIVERY?
 REFERS TO A DELIVERY IN WHICH THE OPERATOR USES
FORCEPS OR A VACUUM DEVICE TO EXTRACT THE
FOETUS FROM THE VAGINA, WITH OR WITHOUT THE
ASSISTANCE OF MATERNAL PUSHING
WHEN IS AN OPERATIVE VAGINAL DELIVERY
INDICATED?
 PROTRACTED SECOND STAGE OF LABOUR
SUSPICION OF IMMEDIATE OR POTENTIAL FOETAL COMPROMISE
SHORTENING THE SECOND STAGE FOR MATERNAL BENEFIT
WHEN IS THE SECOND STAGE OF LABOUR
DESCRIBED AS PROTRACTED?
 FOR NULLIPAROUS WOMEN, A PROTRACTED SECOND STAGE CAN BE DEFINED
AS NO PROGRESS (DESCENT, ROTATION) AFTER ABOUT 3 HOURS WITH
EPIDURAL ANESTHESIA AND ABOUT 2 HOURS WITHOUT EPIDURAL
ANEASTHESIA

FOR MULTIPAROUS WOMEN, A PROTRACTED SECOND STAGE CAN BE DEFINED

AS NO PROGRESS (DESCENT, ROTATION) AFTER ABOUT 2 HOURS WITH
EPIDURAL ANESTHESIA AND ABOUT 1 HOUR WITHOUT EPIDURAL
ANAESTHESIA
WHAT MIGHT FOETAL COMPROMISE REFER TO?
 FOETAL HEART RATE ABNORMALITIES
ACUTE ABRUPTION
WHEN MIGHT SHORTENING THE SECOND STAGE
OF LABOUR BE TO THE BENEFIT OF THE
MOTHER?
 IF THE VALSALVA MANEUVER IS CONTRAINDICATED OR EXERTION SHOULD BE
MINIMIZED BECAUSE OF MATERNAL MEDICAL DISORDERS
TYPICALLY CARDIAC
OR NEUROLOGIC
WHAT ARE THE PREREQUISITES FOR THE USE OF
THE FORCEPS?
 F-FULL DILATION
O-(OS DILATED), OPTION FOR IMMEDIATE CESAREAN SECTION
R-RUPTURED MEMBRANES
C-CEPHALIC PRESENTATION (POSITION, STATION, ASYNCLITISM KNOWN), CONSENT
E-ENGAGED HEAD, EMPTY BLADDER, EXPERTISE
P-PAIN RELIEF (PRESENTATION SUITABLE), PAEDIATRICAIN INFORMED
S-SIZE OF BABY AND PELVIS APPROPRIATE
WHAT INFLUENCES THE TYPE OF FORCEPS
CHOSEN?
 STATION
MID FORCEPS
KEILLAND FORCEPS
LOW FORCEPS/OUTLET FORCEPS
WRIGLEYS FORCEPS
SIMPSON FORCEPS
ELLIOT FORCEPS
 THE SIZE AND SHAPE OF THE FOETAL HEAD
SIMPSON TYPE FORCEPS, WHICH HAVE LONG TAPERED BLADES, TEND TO BE THE
BEST FIT FOR A MOLDED HEAD
ELLIOTT TYPE FORCEPS OR TUCKER-MCLANE TYPE FORCEPS ARE BETTER SUITED
TO A ROUND, UNMOLDED HEAD
 FOETAL HEAD AND POSITION
KIELLAND FORCEPS ARE USEFUL FOR ROTATIONS BECAUSE OF THEIR MINIMAL
PELVIC CURVE AND SLIDING LOCK. THE SLIDING LOCK IS ALSO HELPFUL WHEN
THERE IS ASYNCLITISIM.
PIPER FORCEPS ARE USED TO DELIVER THE AFTERCOMING HEAD IN VAGINAL
BREECH DELIVERIES
 OPERATOR EXPERIENCE AND PREFERENCE
WHAT ARE THE PREREQUISITES FOR THE USE OF
THE VACUUM?
 F-FULL DILATION OR AT LEAST 8CM
O-(OS DILATED), OPTION FOR IMMEDIATE CESAREAN SECTION
R-RUPTURED MEMBRANES
C-CEPHALIC PRESENTATION (POSITION, STATION), CONSENT
E-ENGAGED HEAD, EMPTY BLADDER, EXPERTISE
P-PRESENTATION SUITABLE, PAEDIATRICAIN INFORMED
S-SIZE OF BABY AND PELVIS APPROPRIATE
WHAT TYPES OF VACUUM/CUPS ARE THERE?
 VACUUM
MANUAL VS ELECTRICAL
HANDLE INTEGRATED VS SEPARATE FROM HANDLE

CUP
SOFT VS RIGID
MUSHROOM VS BELL
WHAT CONTRAINDICATES AN OPERATIVE VAGINAL
DELIVERY?
 EXTREME FOETAL PREMATURITY
FOETAL DEMINERALISING DISEASE
FOETAL BLEEDING DIATHESIS
UNENGAGED HEAD
UNKNOWN FOETAL POSITION
BROW OR FACE PRESENTATION
SUSPECTED CPD
WHEN SHOULD ATTEMPTS AT AN OPERATIVE
DELIVERY BE ABANDONED?
 AFTER 3 PULLS/ATTEMPTS
WHAT ARE SOME COMPLICATIONS OF AN
OPERATIVE DELIVERY?
 FOETAL
INTRACRANIAL HAEMORRHAGE
BRUISES
ABRASIONS
LACERATIONS
FACIAL NERVE PALSY
CEPHALOHEMATOMA
RETINAL HAEMORRHAGE
SUBGALEAL HAEMORRHAGE
SKULL FRACTURE
SHOULDER DYSTOCIA
 MATERNAL
LOWER GENITAL TRACT LACERATIONS
VULVAR OR VAGINAL HEMATOMAS
URINARY TRACTINJURY/VOIDINGDYSFUNCTION (URINARY RETENTION OR
INCONTINENCE)
ANAL SPHINCTER INJURY
PAIN
HAEMORRHAGE
INFECTION
WHAT IS A CESAREAN SECTION?
 A SURGICAL PROCEDURE IN WHICH INCISIONS ARE MADE THROUGH A
WOMAN'S ABDOMEN AND UTERUS TO EFFECT DELIVERY OF THE INFANT AND
PLACENTA.
HOW ARE CESAREAN SECTIONS CLASSIFIED?
 BASED ON THE INCISION
LOWER SEGMENT
CLASSICAL
 BASED ON THE INDICATION
MATERNAL VS FOETAL

EMERGENCY/CATEGORY 1
URGENCY/CATEGORY 2
SCHEDULED/CATEGORY 3
ELECTIVE/CATEGORY 4
NAME COMMON MATERNAL INDICATIONS FOR A
CESAREAN SECTION
 PREVIOUS CLASSICAL CESAREAN SECTION
PREVIOUS LSCS X2
LSCS <18/12 TO 2 YEARS AGO
PREVIOUS MYOMECTOMY
PLACENTA PREVIA
LOWER SEGMENT UTERINE FIBROIDS
CPD
NAME COMMON FOETAL INDICATIONS FOR A
CESAREAN SECTION
 FOETAL DISTRESS
MALPRESENTATION
ACTIVE HERPES INFECTION
MATERNAL HIV WITH A HIGH VIRAL LOAD
VASA PREVIA
NAME COMPLICATIONS OF CESAREAN DELIVERY
 EARLY
INJURY TO SURROUNDING STRUCTURES
NEONATAL TRAUMA
HAEMORRHAGE
HYSTERECTOMY
 INTERMEDIATE
VTE
PAIN
HAEMORRHAGE
INFECTION
WOUND
ENDOMETRITIS
 LATE
PLACENTA PREVIA
MORBIDLY ADHERENT PLACENTA
BOWEL OBSTRUCTION
MENSTRUAL IRREGULARITIES
THE END