Gives an overview of instrumental vaginally deliveries

1. G
I
N
A
L
D
E
L
I
V
A
N
D
G
Y
N
A
E
C
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L
O
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A

2. L
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
I
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c
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3. u
c
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
O
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e
v

4. u
c
t
i
o
n

B
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h
m
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d

5. y
[
2
,
3
]

S
a
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s
k
r
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w
r

6. t
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y

W
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S
m
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1792

7. t
o
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y
S
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S

8. t
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y
1
9
8
0
s
:

I
n
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o
d

9. i
o
l
o
g
y

E
s
t
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m
a
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e
d
t

10. n
s
F
o
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U
s
e

M
a
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n
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l

P
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11. d
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c
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t
i
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s

A
b
s
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e

A
b
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o

12. d
i
c
a
t
i
o
n
s

R
e
l
a
t
i
v
e

E
G
A

13. u
i
s
i
t
e
s

I
n
f
o
r
m
e
d
c
o

14. u
i
s
i
t
e
s

E
x
a
c
t
p
o
s
i
t

15. i
n
s
t
r
u
m
e
n
t

O
p
e
r
a
t
o
r
s
k

16. -
V
a
c
u
u
m

T
h
e
s
a
f
e
t
y

18. t
i
n
g
H
o
l
d
t
h
e
c
u

19. r
t
i
o
n

L
u
b
r
i
c
a
t
e
c
u

20. n
p
o
i
n
t

21. n
i
q
u
e

I
n
i
t
i
a
l
v
a
c

22. n
i
q
u
e

T
i
m
e
t
r
a
c
t
i
o
n

23. f
a
i
l
u
r
e

W
h
e
n
d
e
s
c
e
n

24. f
a
i
l
u
r
e

B
a
s
k
e
t
t
e
t

25. o
m
p
l
i
c
a
t
i
o
n
s

F
o
e
t
a
l

L
o
c
a
l
i

27. m
p
l
i
c
a
t
i
o
n
s
.

M
a
t
e
r
n
a
l

L
a
c
e

28. -
F
o
r
c
e
p
s

S
a
f
e
t
y
a
n
d

30. t
a
n
a
t
o
m
y

31. t
a
n
a
t
o
m
y

32. t
a
n
a
t
o
m
y

33. Parts of a forceps

34. o
f
f
o
r
c
e
p
s

O
u
t
l
e
t
f
o
r
c

35. o
f
f
o
r
c
e
p
s

L
o
w
f
o
r
c
e
p
s

T

36. o
f
f
o
r
c
e
p
s

H
i
g
h
f
o
r
c
e
p

37. f
f
o
r
c
e
p
s
O
u
t
l
e
t

W
r
i

38. f
f
o
r
c
e
p
s

39. n
i
q
u
e

C
o
n
f
i
r
m
p
e
l

40. n
i
q
u
e

41. n
i
q
u
e

R
e
p
e
a
t
m
a
n
o
e

42. n
i
q
u
e

C
h
e
c
k
o
f
p
r

43. n
i
q
u
e

44. Sequence of traction
*DBHUF

Downward
s

Backward
s

Horizontall
y

Upwards

Forwards*APPLIES TO VACUUM ALSO

45. n
i
q
u
e

B
e
t
w
e
e
n
c
o
n

46. Forceps failure
• Forceps has failed if:
• Foetal head does not advance with each
pull
• Foetus is undelivered after 3 pulls with no
descent or after 30 minutes[7]
• Every application should be considered a
trial of forceps. Do not persist if no
progress with each pull

47. Potential complications

Foetal

Injury to facial nerves

Lacerations of face and scalp

Fracture of skull and face

Maternal [early]

Lacerations of genital tract

Uterine rupture

48. Potential complications

Maternal [late]

Fistulae

Rectal sphincter dysfunction → faecal
incontinence

Urinary incontinence – less common

49. Post OP care

Active management of third stage

Newborn resuscitation

Umbilical arterial blood gas analysis

Examination for maternal and neonatal
trauma

Documentation of indication, definition
and method of operative technique

Review birth with family

If no major injury, usual 4 – 6 week PNC
visit

50. s
F
o
r
c
e
p
s

R
e
q
u
i
r
e
s
l
e

R
e
q
u
i
r
e
s
m
o

51. s
F
o
r
c
e
p
s

T
r
a
c
t
i
o
n
o
f

T
r
a
c
t
i
o
n
o
f

52. e
p
s
[
m
a
t
e
r
n

53. e
p
s
[
n
e
o
n
a
t

54. Novel devices

Thierry or
Teissier spatula

Odon device

55. The future of OVD ...

Forceps – in doubt!

Skill is declining

Loss of experienced accouchers

2011 records of US vital statistics –
0.7% for forceps

Forceps still an acceptable and safe
option – ACOG[6]

Vacuum or caesarean delivery
favoured over forceps

56. e
r
s
i
e
s
.
.
.

I
f
a
n
d
w
h
e
n

57. u
s
i
o
n

Operative vaginal delivery is an invasive
procedure that requires good
communication with the woman

The need for the delivery must
convincing, compelling and documented

Use the mnemonic to ensure safe
technique and to reduce harm to the
woman and her foetus

58. Update the following ...

Elective OVD indications

Risk factors to a failed OVD

Local studies and statistics

Forceps and vacuum in C/D

Current PMTCT guideline for OVD when
indicated

Include destructive operations and
episiotomies

59. O
U
R
A
U
D
I
E
N
C

60. e
n
c
e
s
1.http://www.uptodate.com/contents/operative-vaginal-delivery
2.http://emedicine.medscape.com/article/263603-overview#a6
3.http://emedicine.medscape.com/article/271175-overview#a1
4.http://emedicine.medscape.com/article/263603-overview#a7
5.B
a
s
k
e
t
t

61. t
o
r
y
S
i
r
J
a
m
e
s
S