Ventose and forceps delivery for undergraduate
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Transcript of Ventose and forceps delivery for undergraduate
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Ventose and Forceps deliveryVentose and Forceps delivery
Dr Manal BeheryPorofessor of Obstetricis &Gynecology
Zagazig University 2014
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Vacuum /ventouseVacuum /ventouse
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IndicationsIndications
MATERNAL
Exhaustion
Prolonged second stage
Cardiac / pulmonary disease
FETAL
Failure of the fetal head to rotate
Fetal distress
Should not be used for preterm, face presentation or
breech
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MNEMONICMNEMONIC
A – Anesthesia adequate
appropriate positioning & access
B – Bladder cathterization
C – Cervix fully dilated / membranes ruptured
D – Determine position, station, pelvic adequacy
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E – Equipment inspect vacuum cup, pump, tubing,
check pressure
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MNEMONICMNEMONIC
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
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G – Gentle traction pull with contractions only\\
traction in the axis of the births canal
ask the mother to push during cont
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H – Halt halt traction if no progress with three traction
aided contractions
vacuum pops off three times
pulling for 30 min without significant progress
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I – Incision consider episiotomy if laceration imminent
J – Jaw remove vacuum when jaw is reachable or delivery assured
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Steps of ventose applicationSteps of ventose application
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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
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Fetal complicationsFetal complications
Scalp injuries chignon
abrasion & lacerations 12.6%
scalp necrosis 0.25-1.8%
Cephalohematoma 25% jaundice /anemia
Intracranial hemorrhage 2.5%
Subgaleal hematoma
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Fetal complicationsFetal complications
Birth asphyxia 2.6-12% related to extraction
force & time
Some studies showed decrease birth asphyxia
Retinal hemorrhage 50%
Forceps 31%
SVD 19%
Neonatal jaundice
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FORCEPSFORCEPS
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IndicationsIndications
MATERNALExhaustion Prolonged second stageCardiac / pulmonary disease
FETALFailure of the fetal head to rotateFetal distressControl of the fetal head in vaginal beech delivery
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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
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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
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After coming head in breech After coming head in breech Piper Piper
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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
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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
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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
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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
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I – Incision consider episiotomy if laceration imminent
J – Jaw remove forceps when jaw is reachable or delivery assured
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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%
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ComplicationsComplicationsFetal 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