OPERATIVE VAGINAL DELIVERY

 Fetal head is at or on perineum

 Delivering vaginally through the use of  Head is occiput anterior or occiput
forceps or vaccum posterior
 May also be used for rotation  Head is right or left OA or OP position
 Occiput Transverse and but rotation </= 45 degrees
posterior positons Prerequisites
 Fetal indications:  Engaged head
- Non-reassuring fetal heart rate  Vertex position
pattern  Known fetal head position
- Premature placental separation  CPD not suspected
 Maternal indications:  Fetal weight estimated
- Heart disease  Experienced operator
- Pulmonary compromise  Ruptured membranes
- Neurological conditions  Completely dilated cervix
- Intrapartum infection  Adequate anesthesia
- Maternal exhaustion and prolonged  Emptied maternal bladder
second stage of labor – most  No fetal coagulopathy
common indication  No fetal demineralization disorders
 The two most important  Willingness to abandon OVD
discriminators of risk for both mother  Informed consent completed
and neonate are:
- Station
- Rotation
 Deliveries are categorized as:
- Outlet
- Low
- Midpelvic procedures
 Has higher degrees of 3rd and fourth
degree lacerations
 Injuries are more common with an
occiput posterior position
 Acute perinatal injury is more common
among operative vaginal delivery than
cesarean or spontaneous vaginal
delivery
 Forceps-assisted vaginal delivery has
higher rates of facial nerve injury,
brachial nerve injury, corneal
abrasion, and depressed skull fracture

Criteria for Outlet forceps delivery

 Scalp is visible at the introitus without
separating the labia
 Fetal skull has reached the pelvic
floor

OPERATIVE VAGINAL DELIVERY MARK NICHOLAS REYES

MD202
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