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    Lecture-31 Instrumental Delivery

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    Madhu Sudhan Pandeya
    This document discusses instrumental delivery methods, including forceps and vacuum extraction. It describes the types of forceps and their application, indicating when each method is appropriate. Potential complications of both forceps and vacuum extraction are outlined. Steps for safe vacuum extraction are provided in a mnemonic format. Images show the application of vacuum cups and the rotation of the fetal head under controlled traction.

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    © All Rights Reserved
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    Lecture-31 Instrumental Delivery

    Uploaded by

    Madhu Sudhan Pandeya
    183 views33 pages
    This document discusses instrumental delivery methods, including forceps and vacuum extraction. It describes the types of forceps and their application, indicating when each method is appropriate. Potential complications of both forceps and vacuum extraction are outlined. Steps for safe vacuum extraction are provided in a mnemonic format. Images show the application of vacuum cups and the rotation of the fetal head under controlled traction.

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    Instrumental Delivery

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    This document discusses instrumental delivery methods, including forceps and vacuum extraction. It describes the types of forceps and their application, indicating when each method is appropriate. Potential complications of both forceps and vacuum extraction are outlined. Steps for safe vacuum extraction are provided in a mnemonic format. Images show the application of vacuum cups and the rotation of the fetal head under controlled traction.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    183 views33 pages

    Lecture-31 Instrumental Delivery

    Uploaded by

    Madhu Sudhan Pandeya
    This document discusses instrumental delivery methods, including forceps and vacuum extraction. It describes the types of forceps and their application, indicating when each method is appropriate. Potential complications of both forceps and vacuum extraction are outlined. Steps for safe vacuum extraction are provided in a mnemonic format. Images show the application of vacuum cups and the rotation of the fetal head under controlled traction.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 33

    Instrumental delivery

    Prepared by:

    Dr. Gehanath Baral


    MBBS,DGO,MD
    Senior Consultant Gynecologist & Obstetrician: Government of Nepal
    Visiting Professor: CTGU
    19th April, 2007

    1
    Obstetric forceps

    2
    Varieties of forceps

    3
    Varieties of forceps

    1. Long curved

    2. Long curved with


    axis traction device

    3. Wrigley’s

    4. Kielland’s

    4
    Type of forceps application
    1. High forceps

    2. Mid cavity forceps

    3. Low forceps: Head station +2 or


    more but not at pelvic floor

    4. Outlet forceps:
    – Fetal head visible at pelvic floor
    – Position: DOA,LOP,ROP
    – Crowning

    5
    Pre-requisites of forceps application
    1. Head Engaged

    2. Cx Dilated

    3. Membrane ruptured

    4. Station and position


    identifiable

    5. No CPD

    6. Empty bladder
    6
    Indication of forceps application

    1. Prolonged 2nd stage

    2. Maternal distress

    3. To decrease maternal effort:


    – Cardiac disease
    – Eclampsia
    – Cerebrovascular disease

    4. Fetal distress

    5. After coming head of breech

    7
    Identifying blade: Rt. & Lt.

    8
    Apply left blade 1st and hold it in position

    9
    Apply right blade

    10
    Lock both blades together

    11
    Direction of pull on low forceps
    application
    1. Downward and backward
    until head comes to perineum

    2. Forward towards operator to


    let head to crown

    3. Upward and forward towards


    mother’s abdomen

    12
    Pull Downward  Anteriorly  Upward

    13
    Complication

    • Genital tract injury

    • PPH

    • Fetal injury:
    – Facial bruising
    – Facial nerve injury
    – Cephalhematoma
    – Skull fracture

    14
    Vacuum extraction

    Contraindication: Pre-requisites:
    • Non-vertex presentation: • Engaged head
    – Face
    – Brow
    – Breech • Membrane ruptured

    • Preterm <34weeks • Empty bladder

    • No bony resistance
    below head
    • Cx >6-8cm

    15
    Mnemonic for Vacuum Extraction

    A Ask for help, Address the patient, and is Anesthesia


    needed.

    B  Bladder empty.

    C  Cervix must be completely dilated.

    D  Determine position

    E  Equipment and Extractor ready.

    16
    F  Apply the cup over the sagittal suture and in relation
    to the posterior Fontanelle.

    G  Gentle traction in the proper axis.

    H  Halt traction when the contraction is over; Halt the


    procedure if you have had disengagement of the cup
    three times, have had no progress in three consecutive
    pulls or three "pop-offs.“

    I  Evaluate for Incision (episiotomy) when the head is


    being delivered.

    J Remove the cup after the Jaw is delivered.

    17
    Vacuum Devices

    18
    19
    Vacuum extractor

    20
    21
    Silicon cup

    22
    23
    Plastic cups
    Disposable Plastic Cup(DPC)(Mityvac device)

    24
    Metal cup

    25
    Rigid Metal cups
    (Also k/a
    Malmstrom cup)
    Parts

    26
    27
    Cup applied to scalp

    28
    Traction on vacuum cup

    29
    Head rotates itself on traction

    30
    Artificial caput formation

    31
    Cephalic Hematoma

    32
    Complication

    1. Laceration of cervix and


    vaginal wall

    2. Sloughing of scalp

    3. Cephalhematoma

    4. Subaponeurotic
    bleeding

    33

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