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Objectives
Indications
Prerequisites
Classification
Methods of application and traction
Comparison of techniques
Documentation
Vacuum Extraction
Vacuum
Indications
Fetal - suspected fetal compromise requiring immediate
delivery
Maternal
- prolonged second stage
- maternal conditions which contraindicate pushing
- conditions requiring a shortened second stage
- maternal exhaustion
Contraindications Absolute
nonvertex, face or brow presentation
unengaged vertex
incompletely dilated cervix
clinical evidence of CPD
Contraindications - Relative
prematurity or EFW < 2500 g
mid-pelvic station
unfavourable attitude
Prerequisites
vertex presentation, term fetus, EFW >2500 g
vertex engaged
cervix fully dilated and membranes ruptured
adequate maternal pelvis by clinical assessment
appropriate analgesia
maternal bladder empty
experienced operator
backup plan if procedure not successful
Avoidance of complications
Confirm indications and conditions for use
Proper anatomical placement
Avoid entrapment of maternal soft tissue
Correct angle of traction
Avoid excessive force/torque
Coordinate traction to maternal effort
Control descent/expulsion
Apply the rule of threes; stop procedure
Axis of Parturition
Vacuum Application/Traction
Incorrect
Correct
VACUUM MNEMONIC
Forceps Delivery
Function of Forceps
obstetrical forceps are for the following functions:
- traction of the fetal head
- rotation of the fetal head
- flexion of the fetal head
- extension of the fetal head
these functions cause fetal head compression
proper use minimizes this compressive force
Indications
Fetal
- suspected fetal compromise requiring immediate
delivery
Maternal
- prolonged second stage
- maternal conditions which contraindicate pushing
- conditions requiring a shortened second stage
- maternal exhaustion
- deflexed attitudes of the fetal head and malposition
Prerequisites
head engaged
cervix fully dilated and ruptured membranes
exact position of the head determined
adequate pelvis
bladder empty
appropriate anaesthesia
experienced operator
adequate facilities and backup available
Low Forceps
leading point of the skull is at station + 2 cm or more
two subdivisions:
- rotation of 45 degrees or less
- rotation more that 45 degrees
Mid Forceps
head is engaged
leading position of the skull is above station + 1 cm
alternative to mid forceps delivery is cesarean
section - access to cesarean is necessary if mid
forceps delivery is attempted
Station
Engagement
when the biparietal diameter of the head enters the
plane of the pelvic inlet
when the leading edge of the skull is at or below the
ischial spines (station 0)
Axis of Parturition
Traction
1) Direction
2) Amount
Head Compression
Rotatio
n
Incorrect (Ouch!)
Correct
FORCEPS MNEMONIC
Comparison of
Forceps and Vacuum
Delivery
VACUUM EXTRACTION
AUDIT TOOL
Patient Demographics
Indications
Prerequisites
Procedure
Outcome