Ventose and Forceps deliveryVentose and Forceps delivery
Dr Manal Behery
Porofessor of Obstetricis &Gynecology
Zagazig Uni...
Vacuum /ventouseVacuum /ventouse
IndicationsIndications
MATERNAL
Exhaustion
Prolonged second stage
Cardiac / pulmonary disease
FETAL
Failure of the fetal h...
MNEMONICMNEMONIC
A – Anesthesia adequate
 appropriate positioning & access
B – Bladder  cathterization
C – Cervix  ful...
E – Equipment  inspect vacuum cup, pump, tubing,
 check pressure
F – Fontanelle  position the cup over the posterior fontan
 -ve pressure ↑ 10 cm H2O initially & between cont
 sweep fi...
G – Gentle traction  pull with contractions only
traction in the axis of the births canal
ask the mother to push during...
H – Halt  halt traction if no progress with three traction
aided contractions
vacuum pops off three times
pulling for 3...
I – Incision consider episiotomy if laceration
imminent
J – Jaw remove vacuum when jaw is reachable
or delivery assured
Steps of ventose applicationSteps of ventose application
11
ComplicationsComplications
Vacuum –assisted delivery is less traumatic to the mother &
fetus than forceps
Ventouse should ...
Fetal complicationsFetal complications
Scalp injuries  chignon
 abrasion & lacerations 12.6%
scalp necrosis 0.25-1.8%
C...
Fetal complicationsFetal complications
Birth asphyxia  2.6-12%  related to extraction
force & time
Some studies showed d...
FORCEPSFORCEPS
IndicationsIndications
MATERNAL
Exhaustion
Prolonged second stage
Cardiac / pulmonary disease
FETAL
Failure of the fetal h...
Classification of forceps deliveryClassification of forceps delivery
Outlet forceps  Scalp visible at the vulva without
s...
Classification Of Forceps DeliveryClassification Of Forceps Delivery
Outlet  Wrigley’s
Outlet & low forceps  Simpson /El...
After coming head in breechAfter coming head in breech  PiperPiper
MNEMONICMNEMONIC
A – Anesthesia adequate /epidural or pudendal
 appropriate positioning & access
B – Bladder  cathteriz...
F – Forceps phantom application
Lt blade , LT hand, maternal Lt side pencil grip &
vertical insertion with Rt thumb dire...
Check application:
 Post fontanelle 1cm above the plane of the shanks
 Sagittal suture lies in the midline of the shank...
G – Gentle traction  applied with contraction & maternal
expulsive efforts
H – Handle elevated  traction in the axis of ...
I – Incision  consider episiotomy if laceration
imminent
J – Jaw  remove forceps when jaw is reachable
or delivery assur...
ComplicationsComplications
Maternal  trauma to soft tissue 3rd
/4th
degree
double the risk compared to ventouse
bleedin...
ComplicationsComplications
Fetal  bruising & laceration to the face
 Injury to the fetal scalp
cephalohematoma 9% Vent ...
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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

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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
  • Ventose and forceps delivery for undergraduate

    1. 1. Ventose and Forceps deliveryVentose and Forceps delivery Dr Manal Behery Porofessor of Obstetricis &Gynecology Zagazig University 2014
    2. 2. Vacuum /ventouseVacuum /ventouse
    3. 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. 4. MNEMONICMNEMONIC A – Anesthesia adequate  appropriate positioning & access B – Bladder  cathterization C – Cervix  fully dilated / membranes ruptured D – Determine  position, station, pelvic adequacy
    5. 5. E – Equipment  inspect vacuum cup, pump, tubing,  check pressure
    6. 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. 7. G – Gentle traction  pull with contractions only traction in the axis of the births canal ask the mother to push during cont
    8. 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. 9. I – Incision consider episiotomy if laceration imminent J – Jaw remove vacuum when jaw is reachable or delivery assured
    10. 10. Steps of ventose applicationSteps of ventose application
    11. 11. 11
    12. 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. 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. 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. 15. FORCEPSFORCEPS
    16. 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. 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. 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. 19. After coming head in breechAfter coming head in breech  PiperPiper
    20. 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. 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. 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. 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. 24. I – Incision  consider episiotomy if laceration imminent J – Jaw  remove forceps when jaw is reachable or delivery assured
    25. 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. 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

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