instrumental vaginal delivery practice.pptx

Vaginal delivery

1. ASSISTED vaginal delivery

2. Indications Maternal : prolonged 2 nd stage maternal exhaustion medical indications to avoid Valsalva mannuvers Fetal : distress thick meconium

3. Contraindications Inexperienced operator Cervix not fully dilated Un engaged fetal head Preterm ( ventous delivery) Predisposition to fracture Bleeding disorders

4. Application / pre requisites A – Address (informed / written) Analgesia Ask for help B – Bladder back up C – cervix contraction

5. D – Determine position
Dystocia
E - Equipment
F - Forcep , safety check G – Gentle traction I – incision J- jaw

6. Documentation… Detailed information on assessment, decision making and conduct of the procedure Plan for postnatal care and sufficient information for counselling in relation to subsequent pregnancies. Use of standardised proforma is recommended. Paired cord Blood sample Incident Report of Adverse outcomes as a part of effective risk management, unsuccessful assisted vaginal birth, major obstetric haemorrhage , OASI, shoulder dystocia and significant neonatal complication

7. Complications FORCEP - maternal cervical, vaginal trauma . OASI PPH urinary retention pain PTSD Fetal Bruising of head Cephal hematoma intracranial bleeding Facial nerve palsy Skull fracture

8. VentousE Maternal Cervical / vaginal wall tear Annular detachment of cervix PPH Fetal Cephalhematoma Skull abrasion Retinal hemorrhage