This presentation gives general overview of 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