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NORMAL VAGINAL DELIVERY
As the foetal head ‘crowns’, your hand is used to control delivery and prevent precipitous/fast delivery.
If a nuchal cord is present it should be reduced at this tie
Steps:
1) Following resttuton of the foetal head, a hand is placed on each parietal eminence and the anterior shoulder
delivered by gentle downward tracton.
2) The posterior shoulder and torso are then delivered by upward tracton.
3) The uibilical cord should be clamped and cut (note: delayed cord claiping has been shown to increase blood fow to
infant thus increase haeiatocrit which iay have clinical beneft in preteri infants).
4) The infant is supported at all ties
5) The third stage of labour (i.e. delivery of placenta and foetal ieibranes) can take place actvely or passively
- Usually lasts ~10iins.
- Uterine contractons result in cleavage of the placenta between the zona basalis ad zona spongiousui
- There are 3 signs of placenta separaton:
o Sudden gush of blood (“separaton bleed”)
o Apparent lengthening of the umbilical cord
o Elevaton and contracton of the uterine fundus
6) The placenta and foetal membranes should be examined and the nuiber of blood vessels in uibilical cord recorded
– If indicated, the placenta iay be sent for pathological exaiinaton.
SURGICAL VAGINAL DELIVERY
ASSISTED VAGINAL DELIVERY
Any surgical procedure designed to expedite vaginal delivery
The choice of which to use is dependent on clinical preference and experience
Indicatons
- Foetal: Distress
- Maternal: Exhauston, Inadequate power, Need to avoid excess expulsive eforts (e.g. CVD, spinal cord injury,
NM disease, HTN crisis, cerebral diseases)
- Labour: Prolonged 2nd stage (>3hrs in nulliparous or >2hrs in iultparous) e.g. ialpresentaton
Criteria
- Fully dilated cervix
- OA positon preferably - OP delivery is possible with Kiellandss forceps and vacuui.
- Ruptured ieibranes.
- Cephalic presentaton.
- Engaged presentng part, ie the greater diaieter of the babyss head has passed the pelvic brii.
- Pain relief is adequate:
o Vacuui extracton or low forceps - iiniiui of perineal nerve block.
o Mid-forceps - epidural or pudendal nerve block, or general anaesthetc.
- Sphincter (bladder) eipty.
- Other: Experienced operator, Ability to perfori eiergency C-secton if
required
Contraindicatons:
- Foetal bleeding disorder
- Foetal fracture risk (e.g. OI)
- Blood born viruses
- Placenta previa
- Vacuui is contraindicated before week 34
FORCEP DELIVERY
Episiotoiy (see below) done just prior to prevent grade >3 tear
Abandon afer a iaxiiui of 3 pulls C-secton
Three types:
- Classic forceps - (e.g. Neville Barnes, Simpson, Tucker-McLane) – Have
pelvic and cephalic curvature – for low-cavity OA deliveries.
- Rotatonal forceps – (e.g. Kielland) – Lacks a pelvic curvature but have sliding shanks. Used for OP presentatons.
- Breech-assistng forceps – (e.g. Piper) - Lacks a pelvic curvature but have long handles on which to place the
body of the breech while delivering the head
Coiplicatons:
- Maternal - perineal injury (esp. with rotatonal forceps), cervical trauma, haemorrhage, infecton
- Foetal - Facial bruising/laceratons, Facial nerve palsy, Skull fracture, Cervical spine injury, Intracranial
haeiorrhage, Shoulder dystocia
- Failed delivery (RF’s – BMI >30, EFW >4kg, OP, Mid-cavity or >1/5th)
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