The document outlines indications and contraindications for assisted vaginal delivery, emphasizing the importance of operator experience and appropriate conditions for the procedure. It details necessary prerequisites, equipment, and steps to ensure safe execution, while also highlighting the importance of documentation and risk management for potential complications. Additionally, it provides a framework for postnatal care and subsequent pregnancy counseling.

1. ASSISTEDVAGINAL
DELIVERY

2. INDICATIONS
• Maternal : prolonged 2nd
stage
maternal exhaustion
medical indications to avoidValsalva mannuvers
• Fetal : distress
thick meconium

3. CONTRAINDICATIONS
• Inexperienced operator
• Cervix not fully dilated
• Un engaged fetal head
• Preterm ( ventous delivery)
• Predisposition to fracture
• Bleeding disorders

4. APPLICATION / PRE REQUISITES
• A – Address (informed / written)
Analgesia
Ask for help
• B – Bladder
back up
• C – cervix
contraction

5. D – Determine position
Dystocia
E - Equipment
• F - Forcep, safety check
• G – Gentle traction
• I – incision
• J- jaw

6. DOCUMENTATION…
• Detailed information on assessment, decision making and conduct of the procedure
• Plan for postnatal care and sufficient information for counselling in relation to
subsequent pregnancies.
• Use of standardised proforma is recommended.
• Paired cord Blood sample
• Incident Report of Adverse outcomes as a part of effective risk management, unsuccessful
assisted vaginal birth, major obstetric haemorrhage, OASI, shoulder dystocia and significant
neonatal complication

8. COMPLICATIONS
FORCEP - MATERNAL
cervical, vaginal trauma
. OASI
PPH
urinary retention
pain
PTSD
FETAL
• Bruising of head
• Cephal hematoma
• intracranial bleeding
• Facial nerve palsy
• Skull fracture

9. VENTOUSE
MATERNAL
• Cervical / vaginal wall tear
• Annular detachment of cervix
• PPH
FETAL
• Cephalhematoma
• Skull abrasion
• Retinal hemorrhage