Assisted Vaginal Delivery Techniques
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Questions and Answers

What are the two types of assisted vaginal delivery?

Forceps and vacuum delivery

What are some procedures discussed in the objectives? (Select all that apply)

  • Discuss pelvic landmarks (correct)
  • Define instrument procedures (correct)
  • Discuss indications and pre-requisites for vacuum and forceps use (correct)
  • Demonstrate proper use of equipment on maternal-fetal mannequin (correct)

Assisted vaginal delivery is a skill used to manage the first stage of labor.

False (B)

What are some examples of Vacuum Extractors? (Select all that apply)

<p>Malmstrom (B), Soft Plastic Cup (C), Rigid Cup (D)</p> Signup and view all the answers

What are some examples of Forceps? (Select all that apply)

<p>Kielland (A), Elliot (B), Piper (C), Simpson (D)</p> Signup and view all the answers

How long is the second stage of labor for a nullipara using a regional anesthetic?

<p>three hours</p> Signup and view all the answers

How long is the second stage of labor for a multipara without a regional anesthetic?

<p>one hour</p> Signup and view all the answers

What are some maternal indications for assisted vaginal delivery? (Select all that apply)

<p>Soft Tissue Resistance with Failure to Descend (A), Drug-Induced Analgesia (B), Hemorrhage (D), Maternal Exhaustion (E), Maternal Illness (F)</p> Signup and view all the answers

What are some pre-requisites for instrument use for assisted vaginal delivery? (Select all that apply)

<p>Vertex Presentation (A), No Known Cephalopelvic Disproportion (B), Complete Dilitatiion of Cervix (C), Willingness to Abandon Procedure (D), Rupture of Membranes (E)</p> Signup and view all the answers

Passage of the biparietal diameter (BPD) through the pelvic inlet is not considered engagement in assisted vaginal delivery.

<p>False (B)</p> Signup and view all the answers

What is the classification of assisted vaginal delivery where the fetal skull is on the pelvic floor?

<p>Outlet Forceps (C)</p> Signup and view all the answers

What is the classification of assisted vaginal delivery where the fetal skull is at, or below, the + 2 station?

<p>Low Forceps (B)</p> Signup and view all the answers

What is the classification of assisted vaginal delivery where the fetal head is engaged but above the + 2 station?

<p>Mid Forceps (C)</p> Signup and view all the answers

What are some advantages to using the Vacuum for assisted vaginal delivery? (Select all that apply)

<p>Soft Cups can Minimize Maternal and Fetal Trauma (A), Rivals Forceps in Safety and Efficacy (B), Rigid Flat Cups Can Be Used for Occiput Posterior or Asynclitism (C), Often Instrument of Preference (D)</p> Signup and view all the answers

Which type of assisted vaginal delivery has the lowest risk of severe birth trauma?

<p>NSVD (C)</p> Signup and view all the answers

Vacuum application must be done with a full bladder

<p>False (B)</p> Signup and view all the answers

Match the following components of Vacuum Application with their descriptions:

<p>A = Ask for help, Address the patient, Anesthesia adequate? B = Bladder Empty C = Cervix Fully Dilated D = Determine position of fetal head E = Equipment and Extractor ready F = Feel for maternal tissue before and after applying vacuum G = Gentle traction at right angles to plane of cup H = Halt traction after contraction I = Evaluate for Incision (episiotomy) J = Remove vacuum when Jaw is reachable</p> Signup and view all the answers

Gentle traction with the vacuum extractor should be done at right angles to the plane of the cup.

<p>True (A)</p> Signup and view all the answers

Vacuum traction should only be applied during contractions.

<p>True (A)</p> Signup and view all the answers

Rotary force or paramedian application of the vacuum extractor should be used to help with delivery.

<p>False (B)</p> Signup and view all the answers

A vacuum procedure should be halted if there is disengagement of the cup three separate times.

<p>True (A)</p> Signup and view all the answers

A vacuum procedure should be halted if there is no progress after three consecutive pulls.

<p>True (A)</p> Signup and view all the answers

What is the maximum time a vacuum can be applied for?

<p>20 minutes</p> Signup and view all the answers

An episiotomy is not necessary when a vacuum extractor is used.

<p>True (A)</p> Signup and view all the answers

The vacuum can be removed when the jaw is reachable.

<p>True (A)</p> Signup and view all the answers

Which of the following statements is true about the advantages of the Vacuum? (Select all that apply).

<p>The vacuum extractor may take longer than using forceps. (B), The vacuum extractor has the potential to increase cephalohematoma. (C), The vacuum extractor requires active maternal efforts. (E), Proper placement and traction are crucial for effective use. (F)</p> Signup and view all the answers

Which of the following are potential complications for vacuum delivery? (Select all that apply).

<p>Intracrainial haemorrhage (B), Sub-galeal hematoma (D), Genital tract trauma (E)</p> Signup and view all the answers

Which of the following are contraindications for vacuum delivery? (Select all that apply).

<p>Delivery requiring excessive traction (A), Transverse lie (B), Incomplete cervical dilatation (C), Breech, face, or brow presentation (E), Severe prematurity (G), Unengaged head (H)</p> Signup and view all the answers

Scalp emphysema, caput formation, and cephalohematoma are all potential signs of birth trauma.

<p>True (A)</p> Signup and view all the answers

What are some things to document in the vacuum operative note? (Select all that apply).

<p>First stage (A), History (B), Third stage (C), Postoperative diagnosis (D), Procedure (E), Second stage (F), Preoperative diagnosis (G), Operation (H)</p> Signup and view all the answers

Forceps application should be undertaken with a full bladder.

<p>False (B)</p> Signup and view all the answers

Match the following components of Forceps Application with their descriptions:

<p>A = Ask for help, Address the patient, Anesthesia adequate? B = Bladder Empty? C = Cervix completely dilated D = Determine position of fetal head E = Equipment ready F = Forceps ready G = Gentle traction = Pajot's Maneuver H = Handle elevated vertically, to follow J-shaped pelvic curve I = Evaluate for Incision (episiotomy) J = Remove forceps when Jaw is reachable</p> Signup and view all the answers

The handle of the forceps should be elevated vertically while pulling.

<p>True (A)</p> Signup and view all the answers

An episiotomy is always required for forceps delivery.

<p>False (B)</p> Signup and view all the answers

The forceps should be removed when the jaw is reachable.

<p>True (A)</p> Signup and view all the answers

What are some potential complications of forceps delivery? (Select all that apply)

<p>Forceps marks (A), Hemorrhage (B), Facial nerve palsy (C), Fractured clavicle (E), Fetal trauma (F), Genital tract trauma (G)</p> Signup and view all the answers

Forceps marks on the baby's head are considered a serious complication.

<p>False (B)</p> Signup and view all the answers

Which of the following statements is true about preventing complications from assisted vaginal delivery? (Select all that apply).

<p>Oxytocin augmentation during the second stage is beneficial for nulliparas (A), The presence of a support person can decrease the length of labor (B), Upright or lateral position may reduce the duration of the second stage of labor (E)</p> Signup and view all the answers

About 10% of vaginal deliveries require assisted delivery.

<p>False (B)</p> Signup and view all the answers

The A-J mnemonic provides a systematic approach to assisted vaginal delivery.

<p>True (A)</p> Signup and view all the answers

Providers should be aware of complications and contraindications for both procedures.

<p>True (A)</p> Signup and view all the answers

Flashcards

Forceps vaginal delivery

A type of vaginal delivery assisted by forceps instruments.

Vacuum (ventose) vaginal delivery

A type of vaginal delivery assisted by a suction cup device.

Subgaleal hematoma

A collection of blood under the scalp of a baby, usually caused by pressure during delivery.

Intracranial hemorrhage

Bleeding inside the skull of a baby, usually caused by birth trauma.

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Fetal trauma

Any injury to the fetus during delivery, potentially caused by instruments or birth position.

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Genital tract trauma

Injuries to the mother's reproductive organs, such as tears to the cervix or vagina, which can occur during delivery.

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Assisted vaginal delivery

A vaginal delivery assisted by instruments or suction.

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Fetal complications

Complications related to the baby's health, such as bleeding or injuries, that can occur during assisted vaginal deliveries.

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Maternal complications

Complications that affect the mother, such as injuries to her reproductive organs, that can occur during assisted vaginal deliveries.

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Risks of assisted vaginal delivery

The use of instruments or suction during delivery can increase the risk of injuries to both the mother and baby.

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Study Notes

Assisted Vaginal Delivery

  • Assisted vaginal delivery is a crucial skill for managing the second stage of labor
  • All maternity care providers must have the knowledge and skills to use vacuum or forceps in emergency situations

Objectives

  • Discuss indications and prerequisites for vacuum and forceps use
  • Discuss pelvic landmarks and define instrument procedures
  • Demonstrate proper use of equipment on a maternal-fetal mannequin

Introduction

  • Assisted vaginal delivery is important for managing the second stage of labor
  • All maternity care providers should have the knowledge and skills to use vacuum or forceps in emergencies

Instruments

  • Vacuum Extractors:
    • Malmstrom: historical, rigid metal cup
    • Soft plastic cup: instrument of choice in most situations
    • Rigid cup: for posterior or asynclitism
  • Forceps:
    • Simpson: all-purpose, suitable for large, molded heads
    • Piper, Elliot, Kielland: special indications

Prolonged Second Stage

  • Nullipara: without regional anesthetic = two hours, with regional anesthetic = three hours
  • Multipara: without regional anesthetic = one hour, with regional anesthetic = two hours

Maternal Indications

  • Maternal exhaustion
  • Drug-induced analgesia
  • Soft tissue resistance with failure to descend
  • Maternal illness (e.g., cardio-respiratory, intracranial)
  • Hemorrhage

Fetal Indications

  • Fetal compromise needing immediate delivery in the second stage
  • Non-reassuring FHR tracing

Prerequisites for Instrument Use

  • Vertex presentation
  • Complete dilation of cervix
  • Rupture of membranes
  • No known cephalopelvic disproportion
  • Willingness to abandon procedure if necessary

Engagement

  • Passage of the BPD (biparietal diameter) through the pelvic inlet
  • Leading edge of the fetal skull at or below the ischial spines

Classification of Assisted Deliveries

  • Outlet forceps or vacuum: Fetal skull on pelvic floor; scalp visible between contractions
  • Low forceps or vacuum: Fetal skull at or below +2 station
  • Mid forceps or vacuum: Head engaged but above +2 station

Vacuum

  • Often the instrument of preference
  • Rivals forceps in safety and efficacy
  • Soft cups minimize maternal and fetal trauma
  • Rigid flat cups for occiput posterior or asynclitism

Incidence of Severe Birth Trauma

  • Lowest risk: Normal Spontaneous Vaginal Delivery (NSVD)
  • Intermediate risk: Delivery by forceps or vacuum alone or by cesarean section
  • Highest risk: Delivery with combined forceps and vacuum extraction or cesarean following failed operative vaginal delivery

Vacuum Application

  • A: Ask for help and ensure anesthesia is adequate
  • B: Ensure bladder is empty
  • C: Ensure cervix is fully dilated
  • D: Determine fetal position; ensure molding position is favorable, consider shoulder dystocia. Posterior fontanel: smaller, forms a Y. Anterior fontanel: larger, forms a cross. Assess for bend in ear. Molding makes assessment difficult.
  • E: Equipment and extractor are ready
  • F: "Flexion point" - proper application results in flexion of fetal head when traction is applied. Check for maternal tissue before and after applying vacuum
  • G: Gentle traction at right angles to the plane of the cup. Only during contractions. Bend, rotary force, or paramedian application will cause detachment
  • H: Halt traction after each contraction. Reduce pressure between contractions, disengagement of cup 3 times = Stop procedure. No progress in three consecutive pulls = stop procedure. Total application duration should not exceed 20 minutes
  • I: Evaluate for incision (episiotomy) when the head is being delivered. Not necessary for vacuum, but may be necessary for shoulder dystocia or difficult delivery
  • J: Remove vacuum when jaw is reachable

Vacuum Contraindications

  • Severe prematurity
  • Breech, face, or brow presentation
  • Transverse lie
  • Incomplete cervical dilation
  • Unengaged head
  • Delivery requiring excessive traction

Post-Vacuum Care

  • Cervix and vaginal exam
  • Evidence of birth trauma (e.g., scalp emphysema, caput formation, cephalohematoma, hyperbilirubinemia, subgaleal hematoma)

Vacuum Operative Note

  • Preoperative diagnosis
  • Postoperative diagnosis
  • Operation
  • History
    • First stage
    • Second stage
    • Third stage
  • Procedure

Forceps Application

  • A: Ask for help, ensure anesthesia is adequate

  • B: Ensure bladder is empty

  • C: Ensure cervix is fully dilated

  • D: Determine fetal head position, consider shoulder dystocia

  • E: Equipment is ready

  • F: Forceps are ready

  • Apply to left side of mother's pelvis, in a cephalic curve towards the vulva.

  • Shank vertical at start. Apply to left side of fetal head using right hand to protect maternal tissue and apply force. Repeat for right side. Articulate handles and lock.

  • Gently traction using Pajot's maneuver. Axis traction follows pelvic curve, initial traction downward, sweeping in a large J-shaped arc. Non-dominant hand exerts downward traction causing horizontal outward and vertical downward vectors of force.

  • Position for safety; posterior fontanel midway between shanks; 1cm above shanks. Fenestrations admit no more than one fingertip. Sutures: lambdoidal above and equidistant from upper surface of each blade; sagittal is midline

  • Handle forceps vertically along J-shaped pelvic curve

  • Evaluate for incision (episiotomy)

  • Remove forceps when jaw is reachable.

Post-Forceps Care

  • Cervical and vaginal exam
  • Evidence of birth trauma (e.g., fractured clavicle, cephalohematoma, lacerations, facial nerve palsy)
  • Forceps marks are normal and benign

Complications

  • Fetal trauma
  • Genital tract trauma

Prevention

  • Upright or lateral position during labor to avoid prolonged second stage.
  • Support person associated reduces labor length and likelihood of operative vaginal delivery
  • Nulliparas with epidurals may benefit from oxytocin augmentation in second stage.

Summary

  • About 5% of vaginal deliveries require operative assistance
  • All maternity care providers must be familiar with instruments and techniques.
  • A → J mnemonic provides a systematic method for assisted delivery.
  • Providers must be aware of complications and contraindications.

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Assisted Vaginal Delivery PDF

Description

This quiz covers the essential skills required for assisted vaginal delivery, focusing on the use of vacuum extractors and forceps in maternity care. Participants will learn about the indications, equipment, and procedures necessary for safe interventions during the second stage of labor. The importance of these skills for maternity care providers in emergency situations is emphasized.

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