2. ASSISTED VAGINAL BIRTH
• No longer is labelled as INSTRUMENTAL DELIVERY.
• 2 METHODS
VACUUM ASSISTED
VAGINAL DELIVERY
FORCEPS ASSISTED
VAGINAL DELIVERY
3. PRE REQUISITES
• F – FULLY DILATED CERVIX
• O – OA/OP
• R – RUPTURED MEMBRANES
• C – CONTRACTIONS/ CONSENT
• E – EMPTY BLADDER/ EXPERIENCED STAFF
• P – PAIN RELIEF/ PELVIS ADEQUATE.
• S – STATION BELOW ISCHIAL SPINES/ 1/5TH POLE PALPABLE PER
ABDOMEN
12. • Left balde – left hand
• Right blade – right hand
• Pencil grip – handle
• Thumb – gentle traction
• Handle – directed downwards
• Blade curvature – upwards
• Right blade locks over left
blade
13. TIPS
• After inserting the blade in posterior vagina vertically
• push the handle of the blade towards the opposite maternal thigh
• Do not take the blade behind and then to the thigh – instead directly towards
the thigh.
• Thumb (of the other hand) gently push the blade into the pelvic side wall.
15. RIGHT HANDED
OPERATOR
• RIGHT hand – fingers hook
the lock from below.
• Left hand – placed over the
lock
• Direction –
• Right hand – forward
and upward
• Left hand – downward
pressure
17. • Episiotomy – right
mediolateral episiotomy
• 8o clock position/ 60
degree angle
• No longer 45 degree.
• Perineal support – thumb
and rest of fingers to
support external anal
sphincter.
18.
19. TRICK
• Choose the right instrument for right station
• Wrigleys – outlet (+3 and below)
• Handles touch the opposite thigh
• Handle – perpendicular to the floor.
• Handle should not be moved – medially or dropped too caudad.
• Rt blade locks over left
• No locking or difficult locking – curve of blade is not properly placed.
• Assess for fetal position again.
20. • bedside ultrasound - Bellussi, et al
• Trajectory does not consider fetal station
• i.e first downward and then horizontal.
26. • FLEXION POINT
• 3cm from posterior fontanelle.
• Middle finger - flexion point
• palmar surface - superior direction,
• back of the finger - contact with
the fourchette
• this is used to determine how far
the ventouse cup must be inserted
28. • CUP – flexion point
• Non pulling hand
• Index finger – scalp
• Thumb on the cup
• Detects the progress
• Detachment of the cup
29. TIPS
GENERATING VACUUM PRESSURE
• STEP WISE
• 8 – 10 MINS
• Traditionally this has been
advised.
• RAPID RISE
• Decrease pressure required for
delivery.
• Decrease the duration of delivery.
• Without posing any risk to mother.
SO ITS TIME FOR A CHANGE OF TECHNIQUE.
32. TIPS
• WHEN TO APPLY TRACTION
• METAL CUP / KIWI OMNI CUP – chignon has to form (1 – 2 min)
• SILASTIC CUP – as soon as pressure is built.
• HEAD DEFLEXED
• Pull – oblique.
• Aim – maintain flexion.
• POP OFF – GOOD
• Excess traction on the cup – pops off – safety to the fetus.
• If pops off – vacuum is released – turn the pressure to 0.2kg/m2 – reapply
the vacuum – increase the vacuum.
35. TRICKS
• Vacuum pressure
• not more than 0.8kg/m2
• Rapid increase.
• Wait for chignon to form.
• Pull – coordinated with maternal uterine contractions.
• Depending on station of presenting part – direction of pull.
• +3 and below – forward – upward.
• +1 and below – downward – forward – upward.
