OPERATIVE VAGINAL

DELIVERY (OVD)

A S E E L A B U A L N I L

OPERATIVE VAGINAL DELIVERY (OVD)

• Operative vaginal delivery (OVD) refers to a vaginal birth with the

use of any type of forceps or vacuum extractor (ventouse)

• OVD = instrumental delivery = assisted vaginal delivery

• .

INDICATIONS

• The indications for OVD can be divided into fetal or maternal,

although in many cases these factors coexist.

The most common fetal factor is suspected fetal compromise,

usually based on a pathological cardiotocograph (CTG).other

indications are abnormal ph ,lactate on fetal sampling ,or thick

meconium

The most common maternal factor is a prolonged active second

stage of labour.

CONTRAINDICATIONS • Safety criteria for operative vaginal delivery consist of:

A. Full abdominal and vaginal examination (Head is minimal palpable per

abdomen, Cervix is fully dilated and the membranes ruptured, Station at

level of ischial spines or below, position of the head, Caput and moulding is

no more than moderate)

B. Preparation of mother (Informed consent, Appropriate anaesthesia, Empty

maternal bladder and Remove in-dwelling catheter or balloon deflated)

C. Preparation of staff (Operator, Adequate facilities, Back-up plan “caesarean

section”, Anticipation of complications, Trained in neonatal resuscitation)

D. When safety criteria are not met OVD is contraindicated

• Forceps and vacuum extractor deliveries before full dilatation of the cervix are

contraindicated

PROCEDURE

Analgesia • Analgesic requirements are greater for forceps than for ventouse delivery

Positioning OVDs are traditionally performed with the patient in the lithotomy

position

Contingency It may be possible to complete a failed vacuum delivery with forceps,

but failed forceps delivery will almost always result in caesarean

section.

1) Vaccum/ventous

INSTRUMENT TYPES Ventouse/vacuum extractors

Technique

–positioning

The cup inserted on flexion point of baby‟s head (2cm anterior to

posterior fontanelle.

Variation of cup sizes depends on baby‟s head

• Soft vacuum cups are significantly more likely to fail to achieve

vaginal delivery than rigid cups; however, they are associated with

less scalp injury.

• There appear to be no difference in terms of maternal trauma.

• Recent developments have removed the need for

external suction generators and have incorporated the

vacuum mechanism into „hand-held‟ pumps (e.g. Omni-

Cup)

• It is not acceptable to use a ventouse when:

• Premature baby‟s

1. The position of the fetal head is unknown.

2. There is a significant degree of caput that may either preclude correct

placement of the cup or, more sinisterly, indicate a substantial degree of

CPD.

3. The operator is inexperienced in the use of the instrument

Forceps

•Obstetric forceps are metal instruments consist of two blades

with shanks used to provide traction, rotation, or both to the

fetal head

•The role of episiotomy at vacuum and forceps delivery is

controversial with conflicting studies reported

https://www.youtube.com/watch?v=y0J3W_W733w

COMPLICATIONS Maternal Complications

have been reported withMaternal deaths vacuum deliveries as a result of

cervical tearing in women delivered before full dilatation.

Traumatic and non-traumatic vaginal delivery is considered to be the most

(anal sphincter injury is twice as fecal incontinence important risk factor for

common with forceps delivery compared to ventouse).

is more common in women needing estimation of blood loss -Underand PPH

OVD compared to women who deliver spontaneously, but less common than

in women delivered by caesarean section in the second stage.

Fetal Complications

•The morbidities for the baby differ with a higher incidence of

cephalhaematoma and cerebral haemorrhage with ventouse and

a higher incidence of lacerations and facial palsy with forceps.

•Risks of trauma to the baby correlate with the duration of the operative

delivery.

1. Side effects FORCEPS>VENTOUS

2. Success FORCEPS>VENTOUS

The ventouse comp to forceps is significantly more likely to be

associated with: (ventouse side effect) 1. Failure to achieve a vaginal delivery.

2. Cephalo-haematoma (subperiosteal bleed).

3. Retinal haemorrhage.

The ventouse compared to forceps is significantly less likely to be

associated with: (forceps side effect) 1. Use of maternal regional/general anaesthesia.

2. Significant maternal perineal and vaginal trauma.

3. Severe perineal pain at 24 hours. ared

CAESAREAN

SECTION

Def :

A caesarean section is a surgical procedure in which

incisions are made through a woman‟s abdomen

(laparotomy) and uterus (hysterotomy) to deliver one or

more babies

it is the most common operation performed worldwide

Increased incidence worldwide during last 25 years

CLASSIFICATION

•ACCORDING TO TIMING:

•- Elective CS

•-Emergency CS

•ACCORDING TO GESTATIONAL AGE:

•-before age of viability (hysterectomy)

•-after the age of viability (caesarean)

•ACCORDING TO UTERINE INCISION

•-Transverse LSCS

•-Vertical (classical)

>CLASSIFICATION ELECTIVE VS EMERGENCY

Elective caesarean sections are usually booked days or weeks ahead of

time

•emergency caesarean section • Category 1: Immediate threat to life of woman or fetus

• Category 2: No immediate threat to life of woman or fetus

• Category 3: Requires early delivery

• Category 4: At a time to suit the woman and maternity services

I N D I C AT I O N S :

T H E F O U R M A J O R I N D I C AT I O N S A C C O U N T I N G F O R G R E AT E R

T H A N 7 0 % O F O P E R AT I O N S A R E :

• P R E V I O U S C A E S A R E A N S E C T I O N .

• M A L P R E S E N TAT I O N ( M A I N LY B R E E C H ) .

• F A I L U R E TO P R O G R E S S I N L A B O U R .

• S U S P E C T E D F E TA L C O M P R O M I S E I N L A B O U R

•RELATIVE INDICATIONS :

•• Fetal distress in first stage of labour or a prolapsed cord.

• • CPD •

•Failure of labour to progress despite adequate stimulation. • To avoid fetal

hypoxia of labour: pre-eclampsia; intrauterine growth restriction.

• • Antepartum bleeding: placenta praevia; abruptio placentae.

•• Poor past obstetric history. • Malpresentations: brow. • Malpositions:

transverse lie, breech.

• • Death of mother in late pregnancy, a live fetus removed peri mortem.

•The only ABSOLUTE ones are:

• • gross disproportion,

•• the higher grades of placenta praevia.

THANKS!