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1

What is the definition of Instrumental delivery and reference?

the goal for instrumental delivery is to almost copy or mimic SVD (Spontaneous Vaginal delivery), conducting delivery with a minimum of maternal or neonatal morbidity. (RCOG,2011)

2

Name the two main types of instrumental delivery

Forceps: they can be Low-Cavity or Mid Cavity,
Vacuum Extraction (Ventouse): Kiwi,Silicone rubber cup and Metal cup

3

what is the incidence of instrumental delivery?

between 2016 and 2017, 59.4% of births where instrumental. (NHS Digital, 2017)

4

Give three reasons why women may need an instrumental delivery.

1. If there is a delay in 2nd stage, NICE (2014) Recommend that if a primiparous women has lasted 2 hrs or a multiparous woman has lasted one hour of active pushing; then a delay in 2nd stage is diagnosed and she should be referred to a health care professional trained to perform instrumental delivery if birth is not close.

2. Malposition

3. Fetal distress

5

Name the things that can prevent an instrumental delivery.

1. An unengaged head
2 Malpresentation (Face/brow)
3. Large baby
4. An operator that is not experienced
5. If the woman has not fully dilated.


6

what are some Risks for mothers during instrumental birth ?

1. Bleeding (PPH)
2. Vaginal tears/ Episiotomy leading to infection if not cared for.
3.Pain relief
4. Bowel and bladder care

7

What are some risks for babies during instrumental birth

1. Bruising on the head (Cephalohaematoma)

2. Bruising on baby's face

3. small marks on baby's face

8

What is the Midwife's role when in delivery suite in an instrumental delivery ?

1. Inform the doctor
2. Gain informed consent from woman
3. Pain relief
4. Bladder Care
5. lithotomy
6.Neonatal Resuscitation equipment
7. Documentation
8. Be sensitive when communicating to the mother and her partner as they may be anxious, fearful,lack of control

9

What area is the analgesia placed and what drug is given as an analgesia?

The analgesia is given in the pudendal nerves and the drug used is 0.5% lidocaine depending on the trust.

10

What is the Mnemonic for a ventouse delivery and reference?

A= Ask for Help, Address the woman, Analgesia

B= Bladder Empty

C= Cervix must be fully dilated

D= Determine position of fetus

E= Equipment and extractor ready

F=Fontanelle (identified and suction cup placed over the sagittal sulture); Forceps lubricated

G= Gentle traction

H= Halt traction and repeat with next contraction (Handles elevated for forceps delivery)

I= Incision (Episotomy) if needed

J= Jaw is reachable so remove suction or forceps to deliver head

11

Name 3 Neonatal complications of a ventouse delivery and references if u can

Cephalohaematoma
scalp abrasions
Retinal haemorrhages

(Werner et al, 2014)

12

Name 3 Maternal complications of a ventouse delivery,

physical and psychological Trauma

Increased risk of PPH (lower risk if forceps)

13

Name three postnatal maternal complications of instrumental delivery

Anal sphincter Injury- depending on the type of instrumental delivery

Perinial trauma

Sexual problem (Macdonald,2013)

Tiredness

14

Name three postnatal neonatal complications of instrumental delivery

Headache

possible feeding problems

Increased risk of Jaundice

15

What is elective Caserean Section and give a reference?

This, is an operative procedure that is usually done under anaesthetic (Regional or General), whereby the baby, placenta and membranes are delivered through the incision made in the abdominal wall and uterus. (Hayman,2015)

16

Incidence of both emergency and elective c-section

In 2015-2016 amount of C-section was 25%

17

Name five reasons for Elective C-section

Previous C-section
Previous 4th degree tear/OASIS
Breech
Multiple pregnancy
Fetal condition (fetus can become stressed)

18

What would you do as antenatal preparation for ELCS?

Disscusion at ANC and date set

Pre-operative assessment

Informed consent

do Observation

Take FBC,G&S (Cross match if necessary)

Anaesthetic discussion and plan

discuss eating and drinking prior to procedure

let mother and partner know how many people would be in room

19

What would you do as Intrapartum care-
pre-op preparation for ELCS?

*Attend at required time and venue
•Pre-operative medication taken (antacid)
•Prepared for theatre (nail varnish/make up removed, gown, jewellery removed, pubic hair prep)
•Catheterised
•Anaesthetic administered
•Partner present (gown)
•Skin prepared and cleaned
•IV antibiotics given during surge

20

Describe the C-section procedure

Incision - usually transverse lower segment
(Clinical incision may be made if placenta previa)

Layers that need to be incised: skin, subcutaneous fat, rectus sheath, (rectus abdominus (muscle) is parted), abdominal peritoneum, uterus (muscle)


The peritoneum above the bladder is incised and the bladder moved out of the way (reflected down)


The uterine muscle should be incised carefully to avoid trauma to the fetus (NB amniotic fluid)

•Cord then clamped and cut

•Baby dried and passed to parents (paediatrician if necessary)

•Skin to skin encouraged in theatre

•Oxytocin IV (5iu) (NICE 2011)

•Placenta and membranes delivered

•Uterus closed in 2 layers, rectus sheath and skin sutured

•Wound dressed

•Vagina swabbed to remove clot

21

What postnatal care would u give to a woman that has just had ELCS?

•Post operative recovery observations (BP, P, R, T, wound, lochia, pain) 15 mins for 30 mins, then 30 mins for 2 hours, hourly then 4 hourly

•Thromboprophylaxis (NICE 2011)
•Pain relief
•Bladder care

•Skin to skin encouraged

•Breastfeeding support

•Wound assessment and care

•Postnatal exercises and PFE encourage

22

Risk Associated with a Cesarean section

increased morbidity/mortality
•Increased risk of VTE
•Increased risk of post-operative infection (wound, UTI, uterine, genital tract)
•Increased blood loss, increased risk postnatal anaemia
•Tiredness
•Pain
•Psychological support