Operative vaginal delivery

OPERATIVE VAGINAL DELIVERY

IQRA YASINRESIDENT, GYNE & OBS UNIT I

SIMS/SERVICES HOSPITAL, LAHORE

INCIDENCE

■ In USA– 1990 9 %– 2006 4.5 % (out of which 3.7 % vacuum, 0.8 % forceps)

■ In UK– 10-13 %

FORCEPS

POSITION OF SAFETY

■ Posterior fontanel should be midway between the shank and 1 cm above the level of shanks; ensuring proper flexion of head and present narrowest diameter to pelvis.– If > 1 cm, then with traction, head will become extended, presenting greater

diameter to pelvis making delivery difficult.

■ Fenestration should be barely just palpable and should not admit not > 1 fingertip– If >1 fingertip is felt, then blades are not insert far enough to be below the fetal

malar eminence and will dig into fetal cheeks, causing potential fetal injury.

■ Lambdoid suture should be above and equal distant from upper border of each blades; ensuring sagittal suture in midline between the blades.

WHEN TO ABANDONED THE PROCESS?■ No progressive descend of head with moderate traction during each

contraction

■ Delivery not imminent following 3 contractions of correctly applied instruments by an experienced operator.

POST PROCEDURE

■ Manage 3rd stage of labor ■ Check the birth canal for tear/laceration: repair if needed■ Repair episiotomy if performed■ Explain care of episiotomy and provide pain relief if needed■ Assessment of neonatal by neonatologist■ DOCUMENTATION (date , time, indication and complication-if any)

FAQs

■ Who should perform OVD?

FAQs

■ Who should perform OVD?

■ ANS: A person who has knowledge, experience and skill necessary to assess to use instrument and to manage complication that may arise.

FAQs

■ Where should OVD take place?

FAQs

■ Where should OVD take place?

■ ANS: Where immediate resource to C-section can be undertaken.

FAQs

■ IF there any place of sequential use of instruments?

FAQs

■ IF there any place of sequential use of instruments?

■ ANS: this is associated with increased risk of trauma to infant. However, the operator must balance the risk of C-section following failed vacuum extraction versus risk of forceps delivery following

failed vacuum extraction.

FAQs

■ What is role of episiotomy for OVD?

FAQs

■ What is role of episiotomy for OVD?

■ ANS: In absence of robust evidence to support routine use of episiotomy in OVD, restrictive use of episiotomy using operator’s

individual judgement is supported.

FAQs

■ Should prophylactic antibiotics be given?

FAQs

■ Should prophylactic antibiotics be given?

■ ANS: there is insufficient data to support it. However, good standard of hygiene are recommended.

FAQs

■ Should thromboprophylaxis be given?

FAQs

■ Should thromboprophylaxis be given?

■ ANS: Woman should be re-assessed after the OVD for the risk factor for the VTE and if appropriate, thromboprophyalxis should be

prescribed.

FAQs

■ How should we advise woman for future deliveries?

FAQs

■ How should we advise woman for future deliveries?

■ ANS: Woman should be encouraged to aim for a spontaneous vaginal delivery in subsequent pregnancy as there is high probability of

success. However, care should be individualized for the woman who have sustained 3rd or 4th degree perineal tear.

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