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.

THANK YOU