Operative vaginal deliveries using vacuum extraction or forceps can be used when there are indications for expedited delivery such as prolonged second stage of labor, fetal distress, or maternal medical complications. Vacuum extraction uses suction cups applied to the fetal head while forceps provide traction, elevation, and rotation. Both have risks of maternal and neonatal injuries. Cesarean section is indicated when vaginal delivery would put the mother or baby at risk, such as cephalopelvic disproportion or non-reassuring fetal status. While cesarean reduces some risks, it also carries increased risks of infection, thrombosis, and longer recovery for the mother.

1. OPERATIVE DELIVERY

2. OPERATIVE VAGINAL DELIVERY
Operative deliveries are vaginal deliveries accomplished with the use of a
vacuum device or forceps
The main function is traction , other function as in forceps is elevation and
rotation

3. INDICATIONS
 Labour related : prolonged second stage of labor (the most common )
 inadequate uterine contractions
 poor expulsive efforts by the mother
 minor disproportion or malposition

4. INDICATIONS
Fetal :
 fetal distress including prolapsed cord in the second stage of labour.
Maternal:
 Poor maternal effort
 severe cardiac, respiratory or hypertensive disease or intracranial
pathology where bearing down effort may be detrimental for her health

5. INDICATIONS BY MRCOG

6. PREREQUISITES TO USE
INSTRUMENT
RCOG

7. VACUUM DELIVERY – VENTOUSE

8. VACUUM DELIVERY
 The cups come in different sizes and are usually 4, 5 or 6 cm in
diameter
 The cup is applied over the flexion point which is 3–4 cm in front of
the occiput on the midline indicated by sagittal suture, It is halfway
between the two parietal eminences and hence promotes flexion to
permit the minimal diameters for the vertex to descend through the
pelvis
 The vacuum pressure is increased to 0.7–0.8 bars or 500–600 mmHg
or 08. kg/cm2 prior to commencement of traction with uterine
contractions and bearing down effort

10. COMPLICATION OF USING VACUUM
 scalp abrasions.
 retinal hemorrhage
 hematoma confined to one of the skull bones,
 neonatal jaundice.
 subgaleal hemorrhage which could cause severe morbidity and
mortality (don’t use before 34 weeks )

11.  The soft tissue sucked into the cup remains as an elevated circular
‘bump’ called ‘chignon’. This soft tissue swelling settles in the next 2–3
days.

12. FORCEPS

13. FUNCTION AND TYPES
 Traction (main )
 Elevation (in cs )
 Rotation
 Rotation best by kielland
 Piper for breech after coming head
 Rigley’s is for outlet delivery

14. CLASSIFICATION (RCOG )

15. APPLICATION

16. COMPLICATIONS OF FORCEPS
 greater incidence of maternal vaginal and perineal lacerations including 3rd
and 4th degree tears compared with vacuum deliveries.
 facial and scalp abrasions
 Facial nerve paralysis
 Cephalhaematomas and fracture of the skull.

17. VACUUM VS FORCEPS
Vacuum extraction compared with forceps is:
● more failure
● more likely to be associated with cephalhaematoma
● more likely to be associated with retinal haemorrhage
● more likely to be associated with maternal worries about baby
● less likely to be associated with significant maternal perineal and vaginal trauma
● same chance of delivery by caesarean section
● same 5-minute Apgar scores
● same need for phototherapy

18. CESAREAN SECTION
 Cesarean section : delivery of a fetus through a surgically created
incision in the anterior uterine wall.
 Primary cesarean is the “first-time” operation, whereas repeat
cesarean refers to the operation done after a prior cesarean

19. CATEGORIES OF CS
Category 1 within 30 mins
Category 2 within 75 mins

20. INDICATIONS
 Maternal-Fetal
 Cephalopelvic disproportion
 Placental abruption
 Placenta previa
 Repeat cesarean delivery
 Cesarean delivery on maternal request

21. INDICATIONS
 Maternal
 Mechanical obstruction of the lower uterine segment (tumors,fibroids)
 Mechanical vulvar obstruction (e.g. extensive condylomata)
 Fetal
 Non-reassuring fetal status
 Breech or transverse lie
 Maternal herpes
 Congenital anomalies

22. Uterine Incision and Delivery of the
Fetus
A low-transverse uterine incision
 associated with less blood loss, easier to perform and
repair, and provides for the option of subsequent
TOLAC
A vertical uterine incision (classical) :
if the lower uterine segment is poorly developed ,
if the fetus is in a backdown transverse lie,
complete anterior placenta previa,
if there are leiomyoma obstructing the lower segment
The disadvantages : greater adhesion formation and a
greater risk for uterine rupture

23. RISKS
 Increased endometritis, transfusion, venous thrombosis rates
 Increased length of stay and longer recovery time
 Increased risk for placenta accreta
 More ARDS before 39 weeks
 Risk of bladder, ureters ,uterine artery bowel injury
 Risk of anesthesia
 Endometritis
 Uterine laceration and hematoma
 More maternal morbidity and mortality
 Fetal scalp injury

24. POTENTIAL BENEFITS
 Reduction in perinatal morbidity and mortality
 Elimination of intrapartum events associated with perinatal asphyxia
 Reduction in traumatic birth injuries
 Reduction in stillbirth beyond 39 weeks’ gestation
 Possible protective effect against pelvic floor dysfunction
 Less primary postpartum hemorrhage