Obstetrics Book

Delivery

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Preparation for Assisted Delivery

Aka: Preparation for Assisted Delivery, Assisted Delivery, Assisted Delivery Complications
  1. Preparation
    1. Preparation for Forceps Assisted Delivery
    2. Preparation for Vacuum Assisted Delivery
  2. Complications
    1. Maternal: Third and fourth-degree Lacerations
      1. Spontaneous Vaginal Delivery: 1.7%
      2. Vacuum extraction: 9.3% risk
      3. Forceps delivery: 19.2% risk
    2. Fetal
      1. Retinal Hemorrhage: Odds Ratio 2.0 higher risk with vacuum more than forceps
      2. Cephalohematoma: Odds Ratio 2.4 higher risk with vacuum more than forceps
      3. Subgaleal Hemorrhage
  3. Technique: (Mnemonic - ABCDEFGHIJ)
    1. Anesthesia adequate?
      1. Perineal Local Anesthesia
      2. Pudendal Block
    2. Bladder empty?
      1. Straight catheterize for urine as needed
    3. Cervix Completely dilated?
    4. Determine head position
      1. Be alert for Shoulder Dystocia
    5. Equipment ready?
      1. Confirm that forceps interlock
      2. Test suction on Vacuum extractor
      3. Replace Scalp Electrode with External Fetal Monitor
    6. Fontanelles ascertained (Position for safety)
      1. Vacuum
        1. Vacuum cup centered on the flexion point
        2. Position vacuum cup anterior to Posterior Fontanelle by 1 cm
        3. Position vacuum cup behind the Anterior Fontanelle
      2. Forceps (for trained and experienced forceps users)
        1. Position
          1. Forceps positioning
        2. For
          1. Forceps Fenestrations (very little of hole palpable)
        3. Safety
          1. Sagittal Suture in line with forceps
    7. Gentle steady traction (Pajot's Maneuver)
      1. Vacuum should only be applied during contraction
    8. Halt traction between contractions
    9. Incision or Episiotomy
      1. When head is being delivered as perineum distends
    10. Jaw seen
      1. Remove Forceps or vacuum as jaw is delivered
  4. References
    1. (2005) ALSO Course

Assisted delivery (procedure) (C0877233)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 U003912
Italian Parto assistito, Parto assistito NAS
Dutch begeleide bevalling NAO, begeleide bevalling
French Accouchement assisté SAI, Accouchement assisté
German Assistierte Entbindung NNB, assistierte Entbindung
Portuguese Parto assistido NE, Parto assistido
Spanish Parto asistido NEOM, Parto asistido
Japanese 介助分娩NOS, 介助分娩, カイジョブンベンNOS, カイジョブンベン
English Assisted delivery (procedure), assisted delivery, assisted deliveries, Procedures Assisting Delivery, Assisted delivery NOS, Assisted delivery
Czech Vedení porodu, Vedení porodu NOS
Hungarian Asszisztált szülés, Asszisztált szülés k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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