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Dr Rabiya Kaussar
TMO MCPS
TYPES OF OVD
• Edmund Piper introduced forceps for after coming head of the breech in 1929
• Wrigley introduced short ligt forcep with generous cephalic curve in 1935
• Branches
• Shanks
• Handle
• Cephalic Curve
• Pelvic Curve
• Perineal Curve
It has been classified by the The American College of Obstetricians and
Gynecologists
(ACOG) in 1994 conference at Washington.
PREREQUISITE
• Vertex presentation
• Cervix is fully dilated and the membranes ruptured
• Head is fully engaged
• Exact position of the head can be determined so proper placement of the
instrument can be achieved
• Pelvis is deemed adequate
• Informed consent must be obtained
• Appropriate analgesia is in place
• Maternal bladder has been emptied
• Adequate facilities and backup personnel are available
• Operator must have the knowledge, experience, and skill necessary to use
the instruments and manage complications that may arise
• Backup plan
3 categories
(1) Classical
• (a)Parallel shanks: Simpson, DeLee, Irving, Hawks-Dennen
• (b)Overlapping shanks: Elliott, Tucker-McLane
Absolute
• non-vertex or brow
• unengaged head
• incomplete cervix dilation
• clinical evidence of cephalopelvic disproportion
• fetal coagulopathy
CONTRAINDICATIONS
Relative
• unfavourable attitude of fetal head
• rotation >45° from occiput anterior or occiput posterior (vacuum)
• mid-pelvic station
• fetal prematurity
• There is a small retrospective study reviewing the outcome of deliveries of
infants 1500 g to 2500 g. No difference was found in Apgar scores, umbilical
pH, or intraventricular haemorrhage when comparing vacuum extraction with
controls who delivered spontaneously
APPLICATION PRINCIPLE AND
PROCEDURE
• (b) the sagittal suture must be perpendicular to the plane of the shanks
throughout its length.
• (c) the fenestration of the blades should be barely felt and the amount of
fenestration felt on each side should be equal. With a solid blade, no more
than a fingertip should be able to be inserted between the blade and the fetal
head one finger-breadth above the plane of the shanks.
MATERNAL COMPLICATIONS
• maternal lacerations
• minor external ocular trauma
• retinal hemorrhage
FETAL COMPLICATIONS
Causes
• Cannot apply the branchs
• Branches do not lock
• Branches slip after application
• While effecting rotation only blades rotate
• Extraction is not possible
• There is morbidity to motality to fetus and mother
FAILED OPERATIVE VAGINAL DELIVERY
• James Young Simpsom devised double valved piston with a metal cup – like
a breast pump
• Parts –
• Metal Cup with Plates (3.4.5.6 mm)
• Traction Chain attached to the plate
• Traction Handle
• Pressure rubber tube whch encloses the traction chain
• Vacuum Bottle with pressure gauge
• Vacuum pump
• Soft Cup –Bell shaped 6.5 mm. Produces symmetric, less cosmetic alarming
caput saccundaneum and less scalp abrasion
• Flexing Median
• Flexing Paramedian
• Deflexing Median
• Deflexing Paramedian
INDICATIONS
Conventional
• Shortening second stage of labour
• Maternal Exhaustion
• Presumed fetal distress
• Occipito- Posterior position
• To deliver second twin if head is presenting part
Non Conventional
• Can be used in Caesarean section
• To deliver frank breech (Charmers)
• Compound presentation
CONTRAINDICATIONS
• Absolute –
• Operator inexperience
• Inability to properly attach
• Inadequate trial of Labour
• High fetal head
• Malpositions
• Aftercoming head of breech
• Known fetal coagulation defect
• Relative –
• Prematurity
• Intrauterine fetal Demise
• Congenital Anomalies
• ‘Prior Scalp Sampling
CHIGNON FORMATION
• The practitioner spreads the labia and introduces the bell shaped cup by
compressing and inserting it into the vagina while angling the device
posteriorly.
• When contact is made with the fetal head, the center of the cup is placed
over the flexion point and symmetrically across the sagittal suture
• The edges of the cup should again be swept with a finger to insure that no
maternal tissues are entrapped.
• Apply suction —
• While lower suction pressures increase the risk of cup "pop-offs," pressures
beyond 600 mmHg increase the risks of fetal scalp trauma and cerebral,
cranial and scalp hemorrhage
• Exert traction —
• The absolute "safe" traction force for vacuum extraction is unknown. In 1962,
one group determined a total traction force of 17.6 kg was typically
necessary to affect delivery
• Traction is applied along the axis of the pelvic curve to guide the fetal vertex,
led by the flexion point, through the birth canal.
• Initially, the angle of traction is downward (toward the floor)
• the higher the beginning station, the steeper the angle of downward traction
required.
• Fetopelvic disproportion
• Incorrect technique
• Large caput succedaneum