1. Operative vaginal delivery.
Dr. Jina khalid mohammed fadl

2. Expectations?????

3. Objectives:
By the end of the session the candidate should be able to :
define operative vaginal delivery .
enumerate :
Types of the operative V.D.
The parts of each instrument.
Types of forceps.
Describe indications, contraindications, prerequisite.
To practice procedure according to ALSO approach

4. Definition
It is delivery in which the operator uses instrument in order to help baby to pass for extra uterine life .

5. 1- Forceps.
2-Vacuum extractor.

6. Indications Maternal : Prolonged second stage of labour.
Maternal exhaustion
Maternal diseases (cardiac ,resp)
Fetal :
Fetal distress.
After coming head of the breech.
Malposition.

7. prerequisite No CPD . Cx fully dilated . Ruptured Membranes .
Bladder empty.
Vertex presentation.
Engaged head.

8. Contraindications Preterm baby <34wks (vacuum extractor ).
Fetal blood sampling
CPD.
Cx not fully dilated
Breech ,shoulder, face (vacuum) .

9. Types of forceps. Outlet forceps. Rotational forceps.
Long curved forceps.

10. Procedure ABCDEFGHIJ appraoch for ventouse.
A: ask for help, address the pt, adequate analgesia.
B: Empty bladder.
C: Cx fully dilated.
D: Determine position,, shoulder dystocia
E: Equipments(Extractor, neonatal resuscitation, episiotomy)

11. F: flexion point 3 cm ant to post font
G :gentle traction with contraction.
H : Halt traction in 3 situations :
 3 pop offs .
 20min since start of procedure.
No progress after 3 consecutive contraction.

12. I: incision for episiotomy.
J: release vaccum after appearance of the jaw.
Then continue delivery of the remainder of the body, suture incision, check for maternal injuries & then document whole procedure.

13. ABCDEFGHIJ approach for forceps.
A: ask for help, address the pt, adequate analgesia
B: Empty bladder.
C: Cx fuly dilated.
D: determine position, Think of shoulder dystocia.
E: equipment (forceps, neonatal resuscitation, episiotomy)

14. F: forceps : right pair, articulation.
G:gentle traction with contraction.
H: Handle elevation .
I : Incision for episotomy.
J: disarticulate after appearance of the jaw.
Then continue delivery of the remainder of the body, suture incision, check for maternal injuries & then document whole procedure.

15. Complication : Failure of the procedure. Maternal: Injuries
Perineal Injury (extension of episiotomy).
Vaginal and Cervical laceration.---PPH.
Fetal : Cephalohaematoma ,intracranial haemorhage, facial palsy ,brachial plexus injury.
Facial & forehead injuries.

16. Thank you