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Instrumental Delivery

This document provides classification and information about instrumental delivery. It discusses: 1. The classification of instrumental delivery including outlet forceps, low forceps, and midforceps based on fetal head station and rotation. 2. Types of forceps including Bimalar biparietal, Wrigley forceps, Barnes-Simpson-Neville forceps. 3. Indications for instrumental delivery including fetal distress, maternal distress, and other medical reasons.

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Ahmed Elmohandes
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164 views25 pages

Instrumental Delivery

This document provides classification and information about instrumental delivery. It discusses: 1. The classification of instrumental delivery including outlet forceps, low forceps, and midforceps based on fetal head station and rotation. 2. Types of forceps including Bimalar biparietal, Wrigley forceps, Barnes-Simpson-Neville forceps. 3. Indications for instrumental delivery including fetal distress, maternal distress, and other medical reasons.

Uploaded by

Ahmed Elmohandes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Instrumental Delivery

Classification of Instrumental Delivery


Procedure Criteria

Outlet Scalp is visible at the introitus without separating the


forceps labia (head on perineum)
Low Head station +2 cm or below, and not on the pelvic floor:
forceps • Rotation ≤ 45 ⁰, or
• Rotation > 45 ⁰.
Midforceps Station is between 0 and +2 cm.
Obstetric forceps
Bimalar biparietal application
Left blade first….left hand
Right blade ….right hand
Follow pelvic curve
Wrigley forceps
Sampson forceps
Barnes-Simpson-Neville
Barnes-Simpson-Neville
Killand forceps
TYPES OF LOCK

English lock sliding lock


Piper forceps
Metal cup of ventouse

Use –ve pressure of 0.8 kg/cm2


Flexing median application
Indications
Fetal • Pulsating prolapsed cord *
• Fetal distress
Maternal • To shorten the second stage* of labour in women
with medical conditions (e.g. cardiac disease,
hypertensive, proliferative retinopathy) or with
previous CS.
• Prolonged second stage ( more than 2 h for
nulliparous women or more than 1 h for
multiparous women without epidural)
• Maternal distress

*Prophylactic
Fetal distress:
FHR: brady-, tachy-, deceleration
Moulding, pelvic caput
Maternal distress:
Vital signs: tachy-, Temp≥ 38
Dehydration
Acidosis and ketonuria
Restlessness
Oedematous vagina, vulva, and cervix.
Prerequisites for operative vaginal delivery
1. Head is engaged.
2. Vertex presentation.
3. Cervix is fully dilated and the membranes ruptured.
4. Exact position of the head can be determined
5. Not obstructed: pelvic caput, irreducible moulding.
6. No contracted pelvis
7. Preparation of mother: consent, analgesia, bladder empty, aseptic
technique.
8. Experienced operator
9. Adequate facilities (equipment, lighting, OR).
Complications
Maternal
1. Soft tissue trauma: vaginal, cervical, labial, periurethral,
lacerations……….traumatic PPH
2. Pelvic hematoma
3. Complete perineal tear
4. Urinary complications: fistula & stress incontinence
5. Psychological trauma
Complications

Fetal
1. Scalp lacerations
2. Cephalhematoma
3. Skull fracture
4. Subgaleal hge
5. ICH
6. Brachial plexus injury
7. Facial nerve palsy
Which instrument is better?

Forceps is more ventouse is more


traumatic to the traumatic to the
mother fetus
Decision to end an operative delivery

1. if there is difficulty in applying the instrument,


2. If there is no appreciable descent with each pull,
3. if descent is not significant following 3 pulls, or
4. the baby has not delivered after 15–20 min.

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