Operative vaginal deliveries are accomplished by applying direct traction on the fetal skull with forceps or by applying traction to the fetal scalp by means of a vacuum extractor

1. Obstetrical Surgeries

2. Obstetrical Surgeries
• Operative vaginal deliveries are accomplished by applying direct
traction on the fetal skull with forceps or by applying traction to the fetal
scalp by means of a vacuum extractor.
• Although considered safe in appropriate circumstances, operative
vaginal delivery has the potential for maternal and neonatal
complications.

3. Forceps
Extraction
01

4. • Forceps are instruments designed to aid in the
delivery of the fetus by applying traction to the
fetal head.
• Generally, forceps consist of 2 mirror image
metal instruments that are maneuvered to
cradle the fetal head and are articulated, after
which traction is applied to effect delivery.

5. •Blades: The blades grasp the fetus. Each blade has a
curve to fit around the fetal head. The blades are oval or
elliptical and can be fenestrated (with a hole in the
middle) or solid. Many blades are also curved in a plane
90° from the cephalic curve to fit the maternal pelvis
(pelvic curve).
•Shanks: The shanks connect the blades to the handles
and provide the length of the device. They are either
parallel or crossing.
•Lock: The lock is the articulation between the shanks.
•Handles: The handles are where the operator holds the
device and applies traction to the fetal head.
Components

6. Procedure
• To prepare, they’ll break the water if it hasn’t broken and drain the bladder
with a catheter if needed. This helps make more room in the birth canal. In
some cases, they may want to perform an episiotomy (a surgical incision of
your perineum) — to make more room for the forceps.
• The delivery assistant will use the rest period between contractions to place
the forceps, one blade at a time, on either side of the baby’s head (or feet).
They'll use your next contraction to apply gentle traction to the forceps to
help guide the baby out.

7. Indications
•Prolonged second stage: This includes nulliparous woman with failure to
deliver after 2 hours without, and 3 hours with, conduction anesthesia. It also
includes multiparous woman with failure to deliver after 1 hour without, and 2
hours with, conduction anesthesia.
•Suspicion of immediate or potential fetal compromise in the second stage of
labor.
•Shortening of the second stage for maternal benefits: Maternal
indications include, but are not limited to, exhaustion, bleeding, cardiac or
pulmonary disease, and history of spontaneous pneumothorax.
•In skilled hands, fetal malpositions, including the after-coming head in
breech vaginal delivery, can be indications for forceps delivery.

8. Prerequisites for forceps delivery include the
following:
•The head must be engaged.
•The cervix must be fully dilated and retracted.
•The position of the head must be known.
•Clinical assessment of pelvic capacity should be performed. No disproportion
should be suspected between the size of the head and the size of the pelvic inlet
and mid pelvis.
•The membranes must be ruptured.
•The patient must have adequate analgesia.
•Adequate facilities and supportive elements should be available.
•The operator should be competent in the use of the instruments and the
recognition and management of potential complications. The operator should
also know when to stop so as not to force the issue.

9. Contraindications
•Any contraindication to vaginal delivery
•Refusal of the patient to verbally consent to the procedure
•Cervix not fully dilated or retracted
•Inability to determine the presentation and fetal head position
•Inadequate pelvic size
•Confirmed cephalopelvic disproportion
•Unsuccessful trial of vacuum extraction (relative contraindication)
•Absence of adequate anesthesia/analgesia
•Inadequate facilities and support staff
•Inexperienced operator

10. Vacuum
Extraction
02

11. Vacuum extraction
• Vacuum extraction, also known as vacuum-
assisted delivery or ventouse delivery, is a
surgical procedure used during childbirth to
assist in the delivery of the baby.
• In vacuum extraction, a soft vacuum cup is
applied to the fetal head and suction is
exerted by means of a mechanical pump

12. Procedure
• The cup is positioned just in the right spot on your
baby’s head, making sure not to trap any vaginal
tissues under it. On the next contraction, they will
apply traction with the mechanical or electric pump.
• Too much suction can cause intracranial
hemorrhage, subgaleal hematomas, scalp
lacerations, and retinal hemorrhage but too little can
cause the cup to detach from the baby’s scalp.
• While applying suction with one hand, they will grasp
the cup with the other hand to try and guide the
baby’s head through the birth canal.
• If the cup detaches repeatedly from the baby’s head,
or if there is any sign of bruising to the baby’s scalp,
the delivery assistant will abandon the vacuum
extractor

13. Indications
•Labor is prolonged or stalled in the second stage
•The baby’s heart rate is considered “non-reassuring” or
•The mother can't push anymore, either due to exhaustion or a health
condition.

14. Contraindications
•Is premature.
•Has not progressed low enough in the birth canal.
•Might not fit through the birth canal.
•Is not positioned headfirst.
•Needs to be rotated.
•Has a bleeding disorder.

15. • Vaginal tears
• Postpartum bleeding
• Difficulty urinating or incontinence.
• Caput succedaneum. Also called scalp edema, this is a swelling of the scalp
• Bruising / Jaundice. This is due to increased bilirubin from the breakdown of red blood cells. It usually
goes away in a few weeks.
• Cephalohematoma.
• Skull Fracture. Newborn skulls are soft and easier to injure. Most fractures are small, heal on their own and
cause no long-term damage.
Complications

16. • Intracranial Hemorrhage. This is bleeding either in or around the
brain. Brain bleeds are rare but can be serious. Common side effects
are apnea and seizures. Less commonly, the bleeding can put
pressure on the brain, causing brain damage.
• Subgaleal Hemorrhage. This occurs when the emissary veins in the
baby’s head are ruptured and blood accumulates within the
connective tissue between the skull and the scalp. Because of the
volume of blood that can accumulate there, this condition can cause
hemorrhagic shock and death if it’s not identified and treated soon
enough. It usually develops gradually over the days following delivery.
SGH occurs in roughly .6% of vacuum-assisted deliveries.

17. • Forceps delivery and vacuum extraction are similar in their risks and
benefits.
• Forceps delivery is the less common option because it requires more skill
and many healthcare providers aren’t adequately trained to use them.
• While vacuum extraction requires your baby to be head-first and not
rotated, forceps can deliver a breech baby (feet first).
• Forceps can be used to help rotate your baby into a better position for
delivery. They also have a higher overall success rate than vacuum
extraction.
Why choose forceps vs. vacuum?

18. Are there any risks to the baby?
● Chignon being made by the ventouse
cup which usually disappears within 48
hours
● Cephalohaematoma that can happen
during a ventouse assisted delivery, but
the bruise is usually nothing to worry
about and should disappear with time
● Marks from forceps on your baby's face
– these usually disappear within 48 hours
● Yellowing of your baby's skin and eyes –
this is known as jaundice, and should
pass in a few days

19. Cesarean
delivery
03

20. • A C-section, also called a cesarean
section or cesarean delivery, is a
surgical procedure in which a baby is
delivered through incisions in your
abdomen and uterus.
• They're performed when a vaginal
delivery is not possible or safe, or when
the health of you or your baby is at risk.

21. Procedure
• Most planned C-sections use an epidural. However, in some cases, it is under general
anesthesia.
• The abdomen will be cleaned with an antiseptic, and you might have an oxygen mask
placed over your mouth and nose to increase oxygen to your baby. Next, your
provider places a sterile drape around the incision site and over your legs and chest.
• The obstetrician will then make an incision through your skin and into the wall of the
abdomen. They might use either a vertical or transverse incision.
• Next, a 3- to 4-inch incision is cut into the wall of your uterus. This incision can also be
transverse or vertical. Finally, the obstetrician removes the baby through the incisions.
The umbilical cord is cut, the placenta is removed and the incisions are closed with
stitches and staples.
• During a planned C-section, the delivery takes about 10 to 15 minutes.

22. Indications
•Cephalopelvic disproportion (CPD): baby's head or body is too large
to pass safely through the pelvis, or the pelvis is too small to deliver an
average-sized baby.
•Previous C-section
•Expecting multiples
•Placenta previa: In this condition, the placenta is attached too low in
your uterus and blocks your baby's exit through your cervix.
•Transverse lie: The baby is in a horizontal, or sideways, position in
your uterus.
•Breech presentation

23. Risks
•Infection.
•Hemorrhage
•Embolism
•A cut that might weaken the uterine wall.
•Abnormalities of the placenta in future pregnancies.
•Risks from general anesthesia.
•Fetal injury.
Other disadvantages of having a C-section are:
•Recovering from a C-section may be more difficult than a vaginal delivery.
•C-sections are more likely to cause chronic pelvic pain.
•More likely to have a C-section in future pregnancies.
•The baby may have trouble breastfeeding
•The baby may be at greater risk for breathing problems.

24. References
• Professional, C. C. M. (n.d.-a). C-section. Cleveland Clinic.
https://my.clevelandclinic.org/health/treatments/7246-cesarean-birth-c-section
• Mph, M. G. R. M. (n.d.). Forceps Delivery: practice essentials, history of the
procedure, epidemiology. https://emedicine.medscape.com/article/263603-
overview?form=fpf
• Professional, C. C. M. (n.d.). Forceps delivery. Cleveland Clinic.
https://my.clevelandclinic.org/health/treatments/23260-forceps-delivery