LABOUR

1. Operative Vaginal
Delivery
GICHANA ELVIS

2. Goals of assisted
operative vaginal
delivery
Reduction of maternal trauma
Prevention of fetal injury
Initial support of the newborn

3. Episiotomy
Incision into perineal body to enlarge
the outlet area and facilitate delivery
May be necessary in cases of dystocia;
accompaniment to forceps; or vacuum
delivery.
Role of prophylactic episiotomy
debatable.

4. Technique
Vertical incision on the perineal body
Can also be made at 45-degree off the
midline
Should be half the length of the perineal
body and extend 2-3 cm into vagina
Too early may cause heavy blood loss
Can be done either before or after
procedure

5. Episiotomy contd.
1st degree: vaginal mucosa involved
2nd degree: submucosa
3rd degree: anal sphincter
4th degree: rectal mucosa
This classification applies to midline
episiotomies and tears

6. Forceps Delivery
Midforceps. Head engaged but above
+2 station
Low forceps. Station +2 or greater
Outlet forceps. Scalp visible without
separating the labia

7. Indications
Prolonged second stage
Maternal exhaustion
Fetal distress
Maternal conditions requiring shortening
of second stage like cardiac disease or
preeclampsia

8. Prerequisite criteria
Fetal head must be engaged in the
pelvis
The cervix must be fully dilated
Exact position and station must be
known
Maternal pelvis type should be known
and it must be adequate

9. Prerequisites contd.
Adequate analgesia time allowing
If done for fetal distress, someone for
neonatal resuscitation should be
present
Operator should be trained in the use
and know the complications

10. Complications
Maternal: Uterine, cervical, or vaginal
lacerations; extension of episiotomy;
bladder or urethral injuries, and
haematomas
Fetal: Cephalohaematomas, bruising,
lacerations, facial nerve injury; skull
fracture and intracranial bleeding

11. Goals of Assisted
Operative Vaginal
Delivery

12. Soft cup vacuum
delivery
Indications, contraindications, and
complications are largely similar to
those of forceps

13. Technique
Cup applied to head away from fontanelles
Vacuum pressure to 0.7-0.8 kg/cc is reached
One hand for traction and the other for flexion
and support of cup
Traction only during contractions
Bladder and rectum must be empty
Do not continue beyond 30 minutesd

14. Comparison of forceps
and vacuum
More maternal
trauma
More blood loss
More 3rd, 4th degree
Similar urinary and
fecal incontinence
Less maternal
trauma
Less blood loss
Less 3rd and 4th
degree laceration
Ditto