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Operative vaginal delivery
- 1. OPERATIVEVAGINAL DELIVERY IQRAYASIN RESIDENT, GYNE & OBS UNIT I SIMS/SERVICES HOSPITAL, LAHORE
- 3. INCIDENCE ■ In USA – 1990 9 % – 2006 4.5 % (out of which 3.7 % vacuum, 0.8 % forceps) ■ In UK – 10-13 %
- 8. FORCEPS
- 17. 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.
- 18. WHENTO ABANDONEDTHE 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.
- 21. 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)
- 23. FAQs ■ Who should perform OVD?
- 24. 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.
- 25. FAQs ■ Where should OVD take place?
- 26. FAQs ■ Where should OVD take place? ■ ANS:Where immediate resource to C-section can be undertaken.
- 27. FAQs ■ IF there any place of sequential use of instruments?
- 28. 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.
- 29. FAQs ■ What is role of episiotomy for OVD?
- 30. 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.
- 31. FAQs ■ Should prophylactic antibiotics be given?
- 32. FAQs ■ Should prophylactic antibiotics be given? ■ ANS: there is insufficient data to support it. However, good standard of hygiene are recommended.
- 33. FAQs ■ Should thromboprophylaxis be given?
- 34. FAQs ■ Should thromboprophylaxis be given? ■ ANS:Woman should be re-assessed after the OVD for the risk factor for theVTE and if appropriate, thromboprophyalxis should be prescribed.
- 35. FAQs ■ How should we advise woman for future deliveries?
- 36. 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.
- 37. THANKYOU