6. F – Fontanelle position the cup over the posterior fontan
-ve pressure ↑ 10 cm H2O initially & between cont
sweep finger around cup to clear maternal tissue
↑ pressure to 60 cm H2O with the next contraction
7. G – Gentle traction pull with contractions only
traction in the axis of the births canal
ask the mother to push during cont
8. H – Halt halt traction if no progress with three traction
aided contractions
vacuum pops off three times
pulling for 30 min without significant progress
9. I – Incision consider episiotomy if laceration
imminent
J – Jaw remove vacuum when jaw is reachable
or delivery assured
12. ComplicationsComplications
Vacuum –assisted delivery is less traumatic to the mother &
fetus than forceps
Ventouse should be the instrument of choice
Maternal Vaginal laceration due to entrapment of vaginal
mucosa between suction cup & fetal head
17. Classification of forceps deliveryClassification of forceps delivery
Outlet forceps Scalp visible at the vulva without
separating the labia
Low forceps Vertex at +2 station
Midforceps Head is engaged but leading part
above +2 station
Sagittal suture not in the AP plane
of the mother
18. Classification Of Forceps DeliveryClassification Of Forceps Delivery
Outlet Wrigley’s
Outlet & low forceps Simpson /Elliot
Midforceps & outlet Tucker Mclane
Midforceps & rotation Kielland
After coming head in breech Piper
19. After coming head in breechAfter coming head in breech PiperPiper
20. MNEMONICMNEMONIC
A – Anesthesia adequate /epidural or pudendal
appropriate positioning & access
B – Bladder cathterization
C – Cervix fully dilated / membranes ruptured
D – Determine position, station, pelvic adequacy
E – Equipment complete working forceps
anesthesia support
21. F – Forceps phantom application
Lt blade , LT hand, maternal Lt side pencil grip &
vertical insertion with Rt thumb directing blade
Rt blade , RT hand, maternal Rt side pencil grip &
vertical insertion with Lt thumb directing blade
Lock blades
22. Check application:
Post fontanelle 1cm above the plane of the shanks
Sagittal suture lies in the midline of the shanks /perpindicular
to the plane of the shanks
The operator can not place more than a fingertip between the
fenestration of the blade & the fetal head on either side
23. G – Gentle traction applied with contraction & maternal
expulsive efforts
H – Handle elevated traction in the axis of the birth canal
do not elevate handle to early
24. I – Incision consider episiotomy if laceration
imminent
J – Jaw remove forceps when jaw is reachable
or delivery assured
25. ComplicationsComplications
Maternal trauma to soft tissue 3rd
/4th
degree
double the risk compared to ventouse
bleeding from lacerations
trauma to urethra & bladder fistula
Pain 17% ventouse 11%
26. ComplicationsComplications
Fetal bruising & laceration to the face
Injury to the fetal scalp
cephalohematoma 9% Vent 25%
retinal hemorrhage 30% Vent 50%
skull fracture
permanent nerve damage / Facial nerve
Editor's Notes
Instrumental deliveries
1-Indications for instrumental deliveries include
T1-Prolonged 2nd stage
T2-Fetal distress
F3-Transverse lie
F4-Compound presentation
T5-Maternal cardiac disease
2-Prerequisite for instrumental delivery include
T1-Cervix must be fully dilated
T2-Membranes ruptured
F3-Fetal head not engaged
F4-Obstetrician unsure about position of the fetal
head due to caput
T5- Bladder empty/ cathetrized
3-Complications of ventouse delivery
F1-Ventouse causes 3rd & 4th degree perineal tears more frequent than forceps
F2-Long term effects on neurological & intellectual development of children delivered by ventouse are evident by 4 years of age
T3-Cephalohematoma occur in up to 25% of babies
T4-Birth asphyxia is related to the force of traction
& prolonged procedure (time from application of
vacuum until delivery)
T5-Cephalohematomas may result in jaundice &
anemia of the neoborne
4-Forceps
T1-can be applied to the after coming head in
assisted vaginal breech delivery
T2-Can be applied to face presentation
T3-It is not contraindicated for preterm fetuses
T4-Can result in facial nerve damage of the fetus
T5-Is associated with a higher fetal mortality than
ventouse