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Ventose and forceps delivery for undergraduate

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Undergraduate course lectures in Obstetrics&Gynecology Prepared by Dr Manal Behery Professor of OB&Gyne Faculty of medicine ,Zagazig University

Undergraduate course lectures in Obstetrics&Gynecology Prepared by Dr Manal Behery Professor of OB&Gyne Faculty of medicine ,Zagazig University


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  • Instrumental deliveries
    1-Indications for instrumental deliveries include
    T1-Prolonged 2nd stage
    T2-Fetal distress
    F3-Transverse lie
    F4-Compound presentation
    T5-Maternal cardiac disease
  • 2-Prerequisite for instrumental delivery include
    T1-Cervix must be fully dilated
    T2-Membranes ruptured
    F3-Fetal head not engaged
    F4-Obstetrician unsure about position of the fetal
    head due to caput
    T5- Bladder empty/ cathetrized
  • 3-Complications of ventouse delivery
    F1-Ventouse causes 3rd & 4th degree perineal tears more frequent than forceps
    F2-Long term effects on neurological & intellectual development of children delivered by ventouse are evident by 4 years of age
    T3-Cephalohematoma occur in up to 25% of babies
    T4-Birth asphyxia is related to the force of traction
    & prolonged procedure (time from application of
    vacuum until delivery)
    T5-Cephalohematomas may result in jaundice &
    anemia of the neoborne
  • 4-Forceps
    T1-can be applied to the after coming head in
    assisted vaginal breech delivery
    T2-Can be applied to face presentation
    T3-It is not contraindicated for preterm fetuses
    T4-Can result in facial nerve damage of the fetus
    T5-Is associated with a higher fetal mortality than
    ventouse
  • Transcript

    • 1. Ventose and Forceps deliveryVentose and Forceps delivery Dr Manal Behery Porofessor of Obstetricis &Gynecology Zagazig University 2014
    • 2. Vacuum /ventouseVacuum /ventouse
    • 3. IndicationsIndications MATERNAL Exhaustion Prolonged second stage Cardiac / pulmonary disease FETAL Failure of the fetal head to rotate Fetal distress Should not be used for preterm, face presentation or breech
    • 4. MNEMONICMNEMONIC A – Anesthesia adequate  appropriate positioning & access B – Bladder  cathterization C – Cervix  fully dilated / membranes ruptured D – Determine  position, station, pelvic adequacy
    • 5. E – Equipment  inspect vacuum cup, pump, tubing,  check pressure
    • 6. F – Fontanelle  position the cup over the posterior fontan  -ve pressure ↑ 10 cm H2O initially & between cont  sweep finger around cup to clear maternal tissue  ↑ pressure to 60 cm H2O with the next contraction
    • 7. G – Gentle traction  pull with contractions only traction in the axis of the births canal ask the mother to push during cont
    • 8. H – Halt  halt traction if no progress with three traction aided contractions vacuum pops off three times pulling for 30 min without significant progress
    • 9. I – Incision consider episiotomy if laceration imminent J – Jaw remove vacuum when jaw is reachable or delivery assured
    • 10. Steps of ventose applicationSteps of ventose application
    • 11. 11
    • 12. ComplicationsComplications Vacuum –assisted delivery is less traumatic to the mother & fetus than forceps Ventouse should be the instrument of choice Maternal  Vaginal laceration due to entrapment of vaginal mucosa between suction cup & fetal head
    • 13. Fetal complicationsFetal complications Scalp injuries  chignon  abrasion & lacerations 12.6% scalp necrosis 0.25-1.8% Cephalohematoma  25%  jaundice /anemia Intracranial hemorrhage  2.5% Subgaleal hematoma
    • 14. Fetal complicationsFetal complications Birth asphyxia  2.6-12%  related to extraction force & time Some studies showed decrease birth asphyxia Retinal hemorrhage 50% Forceps 31% SVD 19% Neonatal jaundice
    • 15. FORCEPSFORCEPS
    • 16. IndicationsIndications MATERNAL Exhaustion Prolonged second stage Cardiac / pulmonary disease FETAL Failure of the fetal head to rotate Fetal distress Control of the fetal head in vaginal beech delivery
    • 17. Classification of forceps deliveryClassification of forceps delivery Outlet forceps  Scalp visible at the vulva without separating the labia Low forceps  Vertex at +2 station Midforceps  Head is engaged but leading part above +2 station  Sagittal suture not in the AP plane of the mother
    • 18. Classification Of Forceps DeliveryClassification Of Forceps Delivery Outlet  Wrigley’s Outlet & low forceps  Simpson /Elliot Midforceps & outlet  Tucker Mclane Midforceps & rotation  Kielland After coming head in breech  Piper
    • 19. After coming head in breechAfter coming head in breech  PiperPiper
    • 20. MNEMONICMNEMONIC A – Anesthesia adequate /epidural or pudendal  appropriate positioning & access B – Bladder  cathterization C – Cervix  fully dilated / membranes ruptured D – Determine  position, station, pelvic adequacy E – Equipment complete working forceps anesthesia support
    • 21. F – Forceps phantom application Lt blade , LT hand, maternal Lt side pencil grip & vertical insertion with Rt thumb directing blade Rt blade , RT hand, maternal Rt side pencil grip & vertical insertion with Lt thumb directing blade Lock blades
    • 22. Check application:  Post fontanelle 1cm above the plane of the shanks  Sagittal suture lies in the midline of the shanks /perpindicular to the plane of the shanks  The operator can not place more than a fingertip between the fenestration of the blade & the fetal head on either side
    • 23. G – Gentle traction  applied with contraction & maternal expulsive efforts H – Handle elevated  traction in the axis of the birth canal  do not elevate handle to early
    • 24. I – Incision  consider episiotomy if laceration imminent J – Jaw  remove forceps when jaw is reachable or delivery assured
    • 25. ComplicationsComplications Maternal  trauma to soft tissue 3rd /4th degree double the risk compared to ventouse bleeding from lacerations trauma to urethra & bladder  fistula Pain 17% ventouse 11%
    • 26. ComplicationsComplications Fetal  bruising & laceration to the face  Injury to the fetal scalp cephalohematoma 9% Vent 25% retinal hemorrhage 30% Vent 50%  skull fracture permanent nerve damage / Facial nerve